Screening for developmental dysplasia of the hip in Greece: current practice and future perspectives

Abstract

Screening for developmental dysplasia of the hip (DDH) in Greece is being performed according to the guidelines issued by the Institute of Child Health in 2015. Screening strategies include universal clinical screening and selective (based on clinical findings or risk factors) sonographic screening. Clinical examination is performed by neonatologists and paediatricians and findings are recorded in the baby’s Health-Book. Whenever clinical examination is suspicious (however non-specific), children are referred for an ultrasound scan and/or to a (paediatric) orthopaedic surgeon. In the case of a positive clinical examination, children are referred to a (paediatric) orthopaedic surgeon, who treats them, when needed. All types of abduction devices are used for treatment (Pavlik, Tubingen), as well as plaster cast, which is preferred in older babies. There are no official guidelines over the selection of the sonographic method for screening; however, the mostly used technique is Graf’s, according to publications from Greek centers. Training of operators on the sonographic examination technique is carried out during radiology residency, depending on hospital availability/expertise, through seminars with hands-on workshops and/or during fellowships. Radiologists and certified paediatric orthopaedic surgeons are the only ones legally allowed to perform neonatal/infantile hip sonography in Greece. Emphasis on the benefits of universal screening and standardized techniques are increasingly taught and repeated, which may eventually influence the decision-making process and standardize the performance of hip sonography within the next few years.