Diagnostic and treatment preferences for developmental dysplasia of the hip: a survey of EPOS and POSNA members

Abstract

Purpose: The aim of this study was to elucidate developmental dysplasia of the hip (DDH) diagnosis and treatment preferences among members of the Pediatric Orthopaedic Society of North America (POSNA) and European Paediatric Orthopaedic Society (EPOS).

Methods: A 54-question survey on DDH diagnosis and treatment preferences was distributed to POSNA and EPOS members. Descriptive statistics were performed.

Results: A total of 459 responses were analyzed. Ultrasound was the preferred modality for diagnosing DDH in infants less than six months old; few surgeons preferred radiographs. In all, 57% of POSNA members had radiology technicians perform ultrasounds, only 7% of EPOS members did. The percent coverage defining a dislocated hip varied greatly, the most frequent response being < 20% for POSNA and < 40% for EPOS members. Pavlik harnesses were the most popular harness/brace, used by 90% of POSNA and 71% of EPOS members. POSNA members were more likely than EPOS members to use a rigid abduction brace following initial harness/brace failure. For residual acetabular dysplasia, POSNA members were twice as likely as EPOS members to institute hip abduction bracing. Most surgeons would not perform closed reduction at less than three months of age or open reduction at less than six months of age. Most EPOS -members used traction prior to reduction; few POSNA members did. Few POSNA and EPOS members believed that reduction should be delayed until the ossific nucleus was visible.

Conclusion: There is great variation in the preferred methods for diagnosing and treating DDH. This survey is the largest transcontinental survey to compile diagnostic and treatment preferences for DDH. With wide variations in practice, there is room for quality improvement.

Keywords: DDH; EPOS; POSNA; developmental dysplasia of the hip; survey.

Figures

Fig. 1

Flowchart of survey respondents (POSNA, Pediatric Orthopaedic Society of North America; EPOS, European Paediatric Orthopaedic Society; DDH, developmental dysplasia of the hip).

Fig. 2

Graph demonstrating harness/brace preferences (POSNA, Pediatric Orthopaedic Society of North America; EPOS, European Paediatric Orthopaedic Society). Respondents were encouraged to select all that apply.

Fig. 3

Graph demonstrating preferred length of treatment for a clinical scenario: ‘Consider a 6-week-old baby with a confirmed dislocated hip that is reducible with gentle manual manipulation, assuming that treatment is working, how long would you treat in harness/brace?’ (POSNA, Pediatric Orthopaedic Society of North America; EPOS, European Paediatric Orthopaedic Society). Respondents were encouraged to select their preferred treatment algorithim.

Fig. 4

Graph demonstrating which scenarios are felt to indicate failed brace treatment (POSNA, Pediatric Orthopaedic Society of North America; EPOS, European Paediatric Orthopaedic Society). Respondents were encouraged to select all that apply.

Fig. 5

Graph demonstrating which radiographic parameters respondents use to evaluate for residual dysplasia (POSNA, Pediatric Orthopaedic Society of North America; EPOS, European Paediatric Orthopaedic Society). Respondents were encouraged to select all that apply.

Fig. 6

Graph demonstrating which time-points respondents recommend for routine surveillance following harness/brace treatment for developmental dysplasia of the hip (DDH) (POSNA, Pediatric Orthopaedic Society of North America; EPOS, European Paediatric Orthopaedic Society). Respondents were encouraged to select all that apply.