Developmental Dysplasia of the Hip and Ultrasound

We now know that in the hands of experts, the use of ultrasonography as a complement to clinical examination has been shown to increase the reliability of diagnosing unstable hips in newborn infants. It is anticipated that with accurate ultrasonography the number of false positive and negative Ortolani and Barlow tests will decrease. However the interpretation of the ultrasound requires well trained personnel in order to avoid the risk of false positive developmental dysplasia of the hip (DDH) being diagnosed and is currently one of the main reasons for not recommending universal screening by ultrasonography for this pupose. If an ultrasound is done in the first few days of life, at the time of clinical suspicion of DDH, and is found to have any "sonographic pathology", it should be repeated at between 2-6 weeks of age. The timing of the repeat ultrasound will depend on the severity of the initial findings and needs to be done because the risks of false positive diagnoses are more likely to occur if the ultrasound is done in the first few days of life. While the underecognition of DDH by clinical criteria is important, what needs to be prevented is the overdiagnosis and overtreatment of DDH by ultrasonography.