Tests
1st tests to order
ultrasound of hips
Test
Preferred radiologic test in infants from 6 weeks to 6 months to confirm clinical findings.
In the presence of positive instability examination, there is limited evidence to support obtaining an ultrasound in infants less than 6 weeks of age.[10]
May be considered in the context of a normal exam if risk factors for developmental dysplasia of the hip (DDH) are present, especially family history of DDH, and/or breech females.[10]
Reliability of ultrasound testing is poor.[19][20][21]
Frank instability or dislocation on ultrasound warrants referral to a pediatric orthopedist for treatment.
In situations where access to a pediatric orthopedist is limited, mild dysplasia (e.g., immaturity of acetabulum without instability) can be followed with serial ultrasound to ensure hip maturation and normal parameters.
Result
subluxation on provocative testing; abnormal relationship between femoral head and acetabulum
hip x-ray
Test
Beyond 6 months of age, hip radiographs are typically preferred over ultrasound as the ossific nucleus has started to ossify. However, the American Academy of Orthopaedic Surgeons (AAOS) indicates that there is low quality evidence supporting the use of an anterior pelvis x-ray instead of an ultrasound to assess DDH in infants beginning at 4 months of age.[10]
An abnormal hip exam is an indication for radiographic evaluation.
Abnormalities on x-ray (anterior-posterior and frog-leg views) warrant referral to pediatric orthopedist.
Result
abnormal relationship between femoral head and acetabulum (assessed by acetabular index, Shenton line, ossification of femoral head)
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