American Academy of Orthopedic Surgeons releases new practice guidelines for infant hip dysplasia.
New clinical practice guidelines for infant hip dysplasia have been released by the American Academy of Orthopedic Surgeons (AAOS) after several years of extensive study. https://www.aaos.org/news/aaosnow/oct14/clinical2.asp Modern guidelines are based on comprehensive review and statistical analysis of the highest quality evidence from all available research. The American Academy of Orthopedic Surgeons should be congratulated for conducting this time-consuming and expensive process. Experts were gathered from several different disciplines to produce the new guidelines, and Kishore Mulpuri, M.D., Director of Research for IHDI, served as Chairman of the task force. The hip dysplasia clinical practice guidelines (CPG) have already been endorsed by the Pediatric Orthopaedic Society of North America (POSNA), the Society of Diagnostic Medical Sonography, and the Society of Pediatric Radiology.
The AAOS hip dysplasia guidelines specifically address screening, early diagnosis and treatment of infants younger than six months of age. In the words of Dr. Mulpuri, “This CPG affects potentially every child who is born. Now we can actually point to what the literature says is the best way to screen these children.” More research is needed but there are two important findings about screening:
- Moderate evidence does not support universal ultrasound screening of newborn infants.
- Moderate evidence supports performing an imaging study before 6 months of age in infants with one or more of the following risk factors: breech presentation, family history, or history of clinical instability
There were some additional findings regarding use of x-rays and treatment methods that will help doctors decide how to manage patients in a more consistent manner. However, there was only limited evidence for specific recommendations in many areas. This is somewhat disappointing, but the guidelines will help serve as a roadmap for future research about hip dysplasia.
The International Hip Dysplasia Institute (IHDI) is already working to find answers for many of the weak areas identified by the guidelines. We are fortunate to have Dr. Mulpuri as our Director of Research to help guide the research agenda for IHDI.
The full guideline, “Management of Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip (DDH) in Infants Up to Six Months of Age,” can be accessed at www.aaos.org/guidelines