DDH Diagnosis: What do we Know so Far?

Abstract

Background: Developmental Dysplasia of the Hip (DDH) is a common disease worldwide. The success of treatment depends on making an early and accurate diagnosis using clinical examination and imaging. Diagnosis of DDH patients is challenging and controversial, and many cases still present late. There is still a lack of consensus among health care providers regarding the diagnostic methods in terms of interpretation, accuracy and appropriate timing. The clinical practice seems to widely vary between healthcare providers in different parts of the world. Aims: We aim to provide a clear pathway to help healthcare professionals from different disciplines in diagnosing DDH at the earliest age possible in order to start an effective treatment and avoid complex procedures and unnecessary complications. We also aim to provide an extensive review that will provide a standardized reference detailing the whole diagnostic process in order to improve the clinical outcome and save resources. Methods: We reviewed the relevant literature using Pubmed, Google Scholar, and the Cochrane library and looked into the references lists of all of these papers to gather all the available evidence. All papers were carefully critiqued to use the most rigorous in the conclusions of this review. We included articles discussing clinical examination and radiological diagnosis. Papers discussing the most used clinical examination tests and the timing of clinical evaluation were reviewed. Also, we looked into papers discussing radiological diagnosis using ultrasound scanning and standard radiographs in terms of sensitivity, specificity and reliability and their relation to patient’s age and other variables. Results: DDH diagnosis must start at a very young age by repeated examination using specific clinical tests looking mainly for signs of major instability. Ultrasound scanning is the investigation of choice in screening and early diagnosis, and the Graf method seems to be the most reliable method. X-rays are not reliable in early diagnosis, especially in the first four months of life, and can lead to over-diagnosis, particularly when using the Acetabular Index as the sole measurement tool. Conclusion: DDH diagnosis has many controversies, and the practice is still widely variable. This review provides an evidence-based, updated pathway for early DDH diagnosis in order to improve the clinical outcome, avoid complications, reduce the need for surgical treatment and save public resources. It highlights some malpractices that are still used in the diagnostic process. The review provides a standardized reference to doctors from different specialties and with different experience levels who are tasked with assessing children for DDH.