Clinical screening of developmental dysplasia of the hip and long-term follow-up after early treatment

Developmental dysplasia of the hip (DDH) is the most common musculoskeletal disorder in early childhood. DDH is clinically screened in the neonatal unit before discharge home after birth by the Ortolani and Barlow tests. If tests are abnormal, ultrasound examination is scheduled later. Recently, the value of clinical screening has been questioned and there is a lack of information on the differences in the predictive value of the two tests. Moreover, the long-term results after early treatment are unclear as some studies have shown a tendency for undercoverage, acetabular dysplasia, development during growth.

This study examined, how often abnormal Ortolani or Barlow test at discharge home results in findings consistent with DDH in hip ultrasound based on electronic patient records. The results revealed that approximately half of the hips with abnormal Ortolani test had dysplasia or instability in ultrasound. This has not been reported in previous studies. Almost all the hips with abnormal Barlow test were normal in ultrasound.

Furthermore, this study assessed the sequelae of DDH in long-term follow-up. We enrolled a follow-up study population at mean 18 years post early treatment for DDH. We found a low prevalence of acetabular dysplasia on radiographs, similar to previously reported normal population. The patient-reported outcomes were comparable between those treated for DDH and their sex- and age-matched controls recruited for this study. However, the treated participants experienced more groin pain in the hip pain provocation tests than did the control participants.

In conclusion, the findings support the use of the Ortolani test for early DDH detection and suggest this test could still be used as a diagnostic tool in neonates if ultrasound is not available in few weeks. The results also highlight the overall excellent prognosis for those treated very early for DDH.