Summary
Definition
History and exam
Key diagnostic factors
- positive Ortolani test
- positive Barlow test
- limited hip abduction
Other diagnostic factors
- abnormal positioning of the leg or delayed crawling/walking
- toe-walking (especially unilateral)
Risk factors
- female sex
- positive family history
- breech presentation
- postural deformity
- restricted intrauterine space
- incorrect lower-extremity swaddling
Diagnostic tests
1st tests to order
- ultrasound of hips
- hip x-ray
Treatment algorithm
<6 months of age
6-18 months of age
>18 months to 6 years of age
>6 years of age
Contributors
Authors
Ishaan Swarup, MD, FAAOS, FAAP
Assistant Professor of Clinical Orthopaedic Surgery
UCSF Benioff Children’s Hospitals
University of California
San Francisco
CA
Disclosures
IS states he has received consulting fees from OrthoPediatrics. He is also the author of a paper cited in this topic.
Acknowledgements
Dr Ishaan Swarup would like to gratefully acknowledge Dr Scott Shipman and Dr Kathleen Moen, previous contributors to this topic.
Peer reviewers
Alex Gornitzky, MD
Assistant Professor of Pediatric Orthopaedic Surgery
University of Michigan
East Lansing
MI
Disclosures
AG declares that he has no competing interests.
Andreas Roposch, MD, MSc, FRCS
Consultant Orthopaedic Surgeon
Reader in Clinical Epidemiology and Surgery
UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust
London
UK
Disclosures
AR declares that he has no competing interests.
Nicholas M. Clarke, ChM, FRCS
Professor
Consultant Orthopaedic Surgeon
Developmental Origins of Health and Disease (DOHaD)
School of Medicine
University of Southampton
Southampton
UK
Disclosures
NMC has received honoraria for visiting professorships in North America and also for lectures in respect of congenital hip dysplasia. He is also a founding member of the International Hip Dysplasia Institute, which has received charitable funding.
References
Key articles
Shipman SA, Helfand M, Moyer VA, et al. Screening for developmental dysplasia of the hip: a systematic literature review for the US Preventive Services Task Force. Pediatrics. 2006;117:e557-e576. Abstract
American Academy of Orthopaedic Surgeons. Detection and nonoperative management of pediatric developmental dysplasia of the hip in infants up to six months of age. Mar 2022 [internet publication].Full text
Shaw BA, Segal LS. Evaluation and referral for developmental dysplasia of the hip in infants. Pediatrics. 2016 Dec;138(6).pii:e20163107.Full text Abstract
American College of Radiology. ACR Appropriateness Criteria: developmental dysplasia of the hip — child. 2018 [internet publication].Full text
Julie S, Quinn RH, Murray J, et al. Management of developmental dysplasia of the hip in infants up to six months of age: intended for use by general pediatricians and referring physicians. J Am Acad Orthop Surg. 2019 Apr 15;27(8):e356-9.Full text Abstract
Samora J, Quinn RH, Murray J, et al. Management of developmental dysplasia of the hip in infants up to six months of age: intended for use by orthopaedic specialists. J Am Acad Orthop Surg. 2019 Apr 15;27(8):e360-3.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Acetabular immaturity
- Proximal femoral focal deficiency
- Residual effects of septic arthritis
More DifferentialsGuidelines
- ACR–AIUM–SPR–SRU practice parameter for the performance of the ultrasound examination for detection and assessment of developmental dysplasia of the hip
- Evidence-based clinical practice guideline: detection and nonoperative management of pediatric developmental dysplasia of the hip in infants up to six months of age
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