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AAOS approves appropriate use criteria for management of developmental dysplasia of the hip in infants
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The American Academy of Orthopaedic Surgeons Board of Directors approved new appropriate use criteria for the management of developmental dysplasia of the hip in infants up to 6 months of age.
To better detect and determine appropriate treatments for nonoperative management of developmental dysplasia of the hip, the appropriate use criteria (AUC) was customized for generalists and referring physicians and orthopedic specialists.
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“Because [developmental dysplasia of the hip] DDH encompasses so many specialties and subspecialties, this AUC provides a forum that can help a physician or orthopedist determine who should be screened by identifying risk factors often associated with DDH,” Antonia F. Chen, MD, MBA, AUC section leader of the AAOS Committee on Evidence-Based Quality and Value, said in a press release. “Pediatricians are often on the first line of evaluating these patients, and now they can be more aware of the risk factors to determine the next best course of action for their patients.”
According to the release, the new AUC supports the clinical practice guideline, “Management of Detection and Nonoperative Management of Pediatric DDH in Infants up to 6 Months of Age,” which has two significant recommendations, both were labeled as having moderate strength with supporting evidence, offering the following guidance:
evidence does not support universal ultrasound screening of newborn infants; and
evidence supports performing an imaging study before 6 months of age in infants with one or more of the following risk factors: breech presentation, family history or history of clinical instability.
As the breech presentation is felt to be a strong risk factor for DDH, the AUC was amended to support a stronger recommendation than the original clinical practice guideline states and recommended a screening ultrasound at 6 weeks and a single anteroposterior pelvis X-ray at 6 months, the release noted.
“In an era where clinicians tend to over-screen patients, this can often lead to over diagnosis and over treatment. The good news is that we are starting to swing the pendulum the other way, and the idea behind this AUC is meant to turn the tide a little to understand that screening is not necessary for every child,” Chen said. “But, we also want parents to understand that if your child was born breech, there’s a family history or a history of clinical instability, then it’s worthwhile to bring it up to your pediatrician or orthopedic surgeon to discuss potentials for screening and follow-up. As with all AUCs, just because the guidelines give suggestions and recommendations, they are not hardline facts that must be followed. Every patient and clinical scenario should be evaluated on an individual basis.”
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