Hip ultrasonography in clinical practice

Abstract

The current practice of hip ultrasonography for developmental dysplasia of the hip (DDH) is based on more than three decades of experience. During this time, professional medical organizations in the United States have addressed both the clinical practice and imaging aspects of early detection of DDH. Current evidence-based clinical practice recommendations come from the American Academy of Pediatrics and the American Academy of Orthopaedic Surgeons. Consensus imaging recommendations come from the American Institute of Ultrasound in Medicine, the American College of Radiology, Society for Pediatric Radiology and the Society of Radiologists in Ultrasound. In this review the author compares and contrasts the current guidelines and offers additional practice tips for those providing comprehensive hip ultrasound services to infants.

Addendum

Since the preparation, submission, and revision of this manuscript, the author has become aware of a recently published update of the American Academy of Pediatrics (AAP) 2000 Guideline cited in this paper. The Section on Orthopaedics of the AAP reviewed the guideline and prepared a Clinical Report entitled “Referral for Developmental Dysplasia of the Hip in Infants” [12]. While not encompassing major changes to the principles of the 2000 report, the new publication makes some clarifications, introduces some specifics on referral, and broadens risk factor description. One of the purposes of the update was to recognize the information in the 2014 clinical practice guideline of the American Academy of Orthopaedic Surgeons (AAOS) included in the above discussion.

A review of the report will reveal changes to the 2000 Guideline add encouragement of healthy hip swaddling and inclusion of history of improper swaddling as a new DDH risk factor. The breech risk factor has been revised to specify third trimester breech for both male and female infants. Regarding the use of imaging, it specifically advises the pediatrician to best defer diagnostic hip US until 6 weeks of age. Additionally, it designates the plain pelvic AP radiograph at 4-6 months as an imaging alternative.