Background: Developmental dysplasia of the hip
) is a common condition, affecting 1% to 2% of full-term infants. The American Academy of Orthopaedic Surgeons (AAOS) and American Academy of Pediatrics have published guidelines detailing best practices for DDH
screening and treatment. The purpose of this survey
was to determine DDH
treatment practices of pediatric orthopaedic surgeons in North America.
We queried orthopaedic surgeon members of the Pediatric Orthopaedic Society of North America (POSNA
) about referral patterns, treatment practices, and use of DDH
guidelines. The survey
included demographics, clinical scenarios, referrals patterns, and ultrasound practices.
Of the 1392 members of POSNA
, we received 432 total responses and included 353 in statistical analyses. Results show that 68% (233/342) of surgeons practice in an institution that does not endorse a standard care pathway for DDH
. Of surgeons who personally use a DDH
care pathway, the AAOS guidelines were most cited (143/353, 41%). The majority (94%, 316/337) of surgeons do not believe that universal ultrasound screening should be adopted in the United States. Responses regarding ultrasound screening for “high risk” infants as outlined by AAOS varied based on risk factor. Many (57%, 200/353) surgeons have performed initial evaluations for patients over 12 months of age. While 80% (260/327) of orthopaedic surgeons believe that primary care providers are referring patients appropriately, only 57% (183/323) believe that primary care providers are ordering imaging studies appropriately.
Results from this survey
membership indicate an opportunity to better distribute and implement DDH
guidelines. In addition, the implementation of a care map with a focus on standard referral and imaging practices could improve the care of patients with DDH
by: (1) reducing the total cost of care, (2) increasing the use of appropriate imaging, (3) increasing timely referral for DDH
care, and (4) reducing the presentation rate of walking age DDH
Level of Evidence:
The level of evidence rating for this survey
-based study is level IV.