Management of Infant Developmental Hip Dysplasia

Screening and Diagnosis

The American College of Radiology recommends no imaging for infants younger than 4 weeks with equivocal physical examination or risk factors alone 1
The American Academy of Pediatrics suggests performing Ortolani and Barlow maneuvers at every well-baby visit (2-4 days, 1 month, 2 months, 4 months, 6 months, 9 months, 12 months) 4
For infants between 4-6 weeks, ultrasound is the imaging modality of choice, with selective screening for high-risk infants or those with abnormal exams 1, 2
The American College of Radiology states that 60-90% of borderline abnormal hips identified by ultrasound resolve spontaneously, making observation appropriate for Graf Type IIa hips in infants under 3 months 4

The American College of Radiology recommends the Pavlik harness as the most effective treatment when applied before 6 weeks of age, with overall success rates of 67-83% 1, 2
The American Academy of Orthopaedic Surgeons suggests using ultrasound to confirm concentric hip reduction and monitor treatment response during harness therapy 1, 2
Predictors of Pavlik harness failure include low post-reduction alpha angle, <20% femoral head coverage, bilateral cases, Graf grade IV hips, and younger age at treatment initiation 1

The American College of Radiology recommends performing serial physical examinations and periodic ultrasound assessments throughout treatment duration 3, 5
Radiography is not preferred during harness treatment due to delayed ossific nucleus appearance and suboptimal positioning within the harness 1, 2
The American Academy of Pediatrics suggests continuing hip examinations at all well-child visits through age 5, with follow-up radiographs at age 1 and 4 years to assess acetabular development 4, 7

The American College of Radiology states that unrecognized and untreated DDH inevitably leads to early degenerative joint disease, with DDH causing up to one-third of total hip arthroplasties in patients <60 years of age 8, 4
Early detection when therapy is noninvasive and most effective is critical for preventing lifelong disability 4, 5