American Academy of Pediatrics – Section on Orthopaedics and the Pediatric Orthopaedic Society of North America

View all recommendations from this society

February 12, 2018

Do not order a screening hip ultrasound to rule out developmental hip dysplasia or developmental hip dislocation if the baby has no risk factors and has a clinically stable hip examination.

Hip dysplasia/dislocation is relatively rare, with incidence of approximately 7 per 1,000 births.  Studies have shown that universal screening programs for developmental hip instability using ultrasounds to assess otherwise normal appearing hips have a nearly negligible positive yield. There is a substantial false positive rate, with an associated increase in treatment rate, suggesting that babies without hip pathology are being treated. When there are no physical findings or underlying risk factors for hip dysplasia/dislocation in a newborn, a hip ultrasound is costly, time-intensive and the findings may be misleading to parents and physicians. This recommendation is in accordance with the 2016 AAP clinical report regarding the use of ultrasound in early detection of developmental dysplasia of the hip (see reference: “Evaluation and Referral for Developmental Dysplasia of the Hips in Infants”).


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Pediatric Orthopaedic Society of North America (POSNA) Evidence Based Medicine Committee and the Advocacy Committee worked together during 2014 and 2015 to develop five items in the practice of Pediatric Orthopaedics of tests or procedures that should not be done routinely. Approximately 20 members of these two committees participated in the process. Each surgeon, in a blinded fashion, submitted 5 items each from their practices and experience of tests or procedures that they found were commonly over-utilized. The items were tallied in order of number of times that item was listed by each surgeon. A total of 30 items were submitted. Both committees then agreed on final list of 5 items based of frequency of responses and importance of the condition. The Evidence Based Committee reviewed the appropriate literature to provide references and support for each item. The Executive Committee of the Orthopaedic Section of the American Academy of Pediatrics (AAP) reviewed the 5 listed items and provided further feedback. POSNA Board of Directors provided further feedback and voted on the final list. Various expert committees and sections of the AAP reviewed and approved the list. The AAP Executive Committee granted final approval of the list.

Sources

Mahan ST, Katz JN, Kim YJ.  To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip.  J Bone Joint Surg Am. 2009 Jul:91(7):1705-1719.

Laborie LB, Markestad TH, Davidsen H. Bruras KR, Aukland SM, Bjorlykke JA, Reigstad H. Indrekvam K, Lehmann TG, Engesaeter IO, Engesaeter LB, Rosendahl K. Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective study during 1991-2006. Pediatri Radiol. 2014 Apr;44 (4): 410-424.

Shorter D, Hong T, Osborn DA. Cochrane Review:  Screening programs for developmental dysplasia of the hip in newborn infants.  Evid Based Child Health. 2013; 8(1): 11-54.

Shaw BA, Segal LS, Section on Orthopaedics.  Evaluation and referral for developmental dysplasia of the hip in infants. Pediatrics 2016; 138(6).