Improving Surveillance Duration for Developmental Dysplasia of the Hip: A Single-Center Retrospective Quality Improvement Initiative.

Authors

Isabella Bozzo, Marianne Gagnon, Jack Legler, Pasin Tangadulrat, Thierry Benaroch

Published in

Journal of pediatric orthopedics. Nov 12, 2026. Epub Nov 12, 2026.

Abstract

Developmental dysplasia of the hip (DDH) relies on early detection. At present, the American Academy of Pediatrics recommends ultrasound (US) screening for patients <6 months of age with breech gestation or a first-degree family history. However, little data exists on long-term surveillance strategies for these high-risk patients with a normal initial screening US. Currently, institutional surveillance includes a follow-up pelvic radiograph (PXR); however, its utility in detection remains unknown. Hence, the goal of this quality improvement initiative was to determine the rates of delayed DDH requiring surgical intervention in high-risk patients with normal screening US.
This quality improvement project was a retrospective cohort review of infants referred to a single pediatric orthopaedic centre from 2020 to 2023 who underwent DDH US screening from 5 weeks to 6 months of age and had a normal initial US. Referral criteria included: (1) a first degree relative with DDH or (2) breech gestation. The primary outcome was the prevalence of treatment with either closed or open reduction and/or other surgical interventions. Patients were excluded if they were referred for concerning physical examination findings or if they did not have risk factors, teratologic DDH, syndromic conditions, or neuromuscular conditions.
A total of 4233 patients were referred for a screening US, and 2497 (59.0%) returned for a surveillance PXR at 12 to 18 months. After the first follow-up, 271 (6.4%) had borderline dysplasia, requiring annual PXR surveillance. Of them, 28 (0.7%) remained under active surveillance. Until January 2026, none of the 4233 patients with risk factors and a normal screening US developed dysplasia requiring treatment.
In patients with risk factors for DDH, referred for screening with a normal US, annual PXR surveillance did not identify any cases of delayed DDH requiring treatment. A manual chart review of a subset of 100 patients validated the database search strategy and identified no missed cases. However, the possibility of undetected cases in the overall cohort cannot be excluded, although these are expected to be rare. This suggests that surveillance protocols may be safely reduced to limit radiation, unnecessary hospital visits, and parental anxiety.
Level III-retrospective cohort.

PMID:
43012677
Bibliographic data and abstract were imported from PubMed on 11 Nov 2026.

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