Diagnosis and treatment of developmental dysplasia of the hip in the Netherlands: National questionnaire of paediatric orthopaedic surgeons on current practice in children less than 1 year old

Abstract

PurposeThere is no consensus in the literature regarding the diagnosis and treatment of developmental dysplasia of the hip (DDH). We designed a national questionnaire to assess the various opinions and current practice of paediatric orthopaedic surgeons in the Netherlands regarding the diagnosis and treatment of DDH in children less than 1 year old.MethodsThe questionnaire was sent to all members of the Dutch Paediatric Orthopaedic Society (DPOS). It discusses different methods and criteria used in the diagnosis of DDH, the use of different therapies and the use of different imaging techniques to evaluate the result of treatment.ResultsWith 38 responders, the overall response rate to the survey was 67%. Most surgeons use clinical, radiographic and/or ultrasound examination for the diagnosis. The starting point of treatment is usually on the mild part of the DDH spectrum. The Pavlik harness is most popular in the treatment of dislocated hips, whereas in dysplastic hips, most surgeons use a rigid splint. The duration of treatment has a wide range and evaluation of the effect of treatment is predominantly done by radiography.ConclusionsThe diagnosis and treatment of DDH in the Netherlands has as much diversity as the literature has recommendations about this subject. The lack of consensus on many aspects of DDH diagnosis and treatment should form the basis for a discussion among Dutch paediatric orthopaedic surgeons. Using the available evidence, it should be possible to formulate a more uniform protocol for the diagnosis and treatment of DDH.

Diagnostic and treatment preferences for developmental dysplasia of the hip: A survey of EPOS and POSNA members

“…Evidence-based guidelines for the treatment of developmental dysplasia of the hip (DDH) have been published, 1 but only low to moderate quality evidence supports these recommendations. Consequently, continued variations in diagnosis 2 - 5 and treatment 2 , 4 regimens have been documented. These previous studies primarily evaluated differences within national societies, 2 , 5 although, one study did evaluate diagnostic criteria for surgeons from across Europe.…”

“…Consequently, continued variations in diagnosis 2 - 5 and treatment 2 , 4 regimens have been documented. These previous studies primarily evaluated differences within national societies, 2 , 5 although, one study did evaluate diagnostic criteria for surgeons from across Europe. 3 Only one study was transcontinental and included surgeons from select centres in five countries; this study looked at the demographics and initial treatment of children with DDH, demonstrating regional variations in treatment.…”

Role of arthrography in assessing the closed reduction in treatment of DDH.

“…Arthrography is also helpful in determining the cause of failure or redislocation if it occurs and further planning of the treatment. 2,3,5,7 Arthrography is helpful in diagnosing "(1) whether mild dysplasia is present, (2) whether the femoral head is subluxated or dislocated, (3) whether manipulative reduction has been or can be successful, (4) to what extent any soft structures within the acetabulum may obstruct with complete reduction of the dislocation, (5) the condition and position of the acetabular labrum (the limbus), and (6) whether the acetabulum and femoral head are developing normally during treatment". 2,5,10 Arthrography can be done by any methods described in the literature i.e.…”

“…Diagnosis of DDH was confirmed with clinical examination and radiological investigations. 4 Then patient was taken to operating room. Under general anesthesia and full aseptic measures 5 , findings of clinical examination were confirmed, patient was draped and adductor tenotomy 6 was done.…”

Diagnostik und Therapie der Säuglingshüfte – sind sich die deutschsprachigen Kinderorthopäden einig?

“…Letztlich sind sich die Mitglieder der deutschsprachigen Vereinigung für Kinderorthopädie hinsichtlich des diagnostischen und therapeutischen Vorgehens bei Säuglingen mit dysplastischen oder dezentrierten Hüftgelenken ähnlich uneinig wie die niederländischen Kollegen. Eine von Heeres et al[15] unter den Mitgliedern der niederländischen Vereinigung für Kinderorthopädie durchgeführte Umfrage ergab u. a., dass in den Niederlanden für ⅓ der Kollegen der AC-Winkel in der Röntgen-Beckenübersichtsaufnahme, für ein weiteres Drittel das Vorliegen einer Abspreizhemmung und für lediglich ⅕ der sonografische Befund wegweisend ist für die Diagnosestellung im 1. Lebensjahr.Die Ultraschalluntersuchung der Säuglingshüfte befindet sich auch 15 Jahre nach Einführung in die "Kinderrichtlinien" fast ausschließlich in ärztlicher Hand.…”