Guidelines for preventive activities in general practice

Musculoskeletal disorders

Hip dysplasia

      1. Hip dysplasia

Musculoskeletal disorders | Developmental dysplasia of the hip

Screening age bar

0-9* 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 ≥80
*Newborn to 6 months underneath this age bar

Developmental dysplasia of the hip (DDH) includes a wide spectrum of anatomical and functional abnormalities of the hip joint.1 This occurs when there is an incorrect relationship of the femoral head to the acetabulum, leading to poor development (dysplasia) of one or both, as well as the surrounding supporting structures of the hip joint leading to instability.1 Global incidence is variable but estimated at 1–2/1000 live births.1 There is an increased incidence in females, breech position, family history.1,2

DDH in infancy has no signs or symptoms, thus screening and surveillance are required for early diagnosis. Early diagnosis aims to avoid the more invasive treatments required in late diagnosis and the long-term sequelae of growth disturbance and avascular necrosis.1,2 The aim of screening is to identify hip dislocation of the hip or DDH before age 6 months. Screening does not need to continue outside of hospital if the baby is being seen by a maternal child health service. GPs will generally see children for DDH concerns upon referral from a maternal child health check.

Screening

Recommendation Grade How often References
Routine newborn and postnatal checks should be performed to detect DDH.
The assessment should include detection of limb length discrepancy, examination for asymmetric thigh or buttock (gluteal) creases, performing the Ortolani test for stability (performed gently, and which is usually negative after age 3 months), and observing for limited abduction (generally positive after age 3 months).
Practice point At newborn and postnatal checks 1,2
 
Routine universal ultrasonography screening for DDH is not recommended. Ultrasound is only recommended for suspicion of DDH. Practice point N/A 1,2

Case finding

Recommendation Grade How often References
There should be continuing periodic physical examination surveillance throughout infancy. Practice point Opportunistically. 1,2
 

Case finding should continue after the immediate postnatal period as dysplasia can progress over the first few months of life.

Screening for DDH should include assessing for leg length discrepancy, asymmetric gluteal folds, Ortolani test and asymmetrical hip abduction. The Ortolani test should only be performed if a clinician is confident in their technique and experienced at neonatal examination. Their utility is in the first 3 months of life. After the first 3 months a dislocated hip will be fixed, and unilateral limited hip abduction (<60 degrees) is the most sensitive examination finding. Asymmetric gluteal folds on their own are a ‘soft’ sign and should be considered in light of risk factors, other examination findings and concerns. Once a child is walking, DDH may present as an abnormal gait.

Imaging for investigation of abnormal examination or a high-risk infant up to 6 months of age should be ultrasound of the hip by an experienced paediatric ultrasonographer, and plain AP view pelvis X-ray in children over 6 months of age.

There are no specific recommendations or advice for Aboriginal and Torres Strait Islander people.

  1. Marriott E, Twomey S, Lee M, Williams N. Variability in Australian screening guidelines for developmental dysplasia of the hip. J Paediatr Child Health 2021;57(12):1857–65.
  2. Shaw BA, Segal LS. Evaluation and referral for developmental dysplasia of the hip in infants. Paediatrics 2016; 138(6):e20163107.
This event attracts CPD points and can be self recorded

Did you know you can now log your CPD with a click of a button?

Create Quick log

Related documents

  Lifecycle-chart.pdf (PDF 0.12 MB)

Advertising