ABSTRACT
Justification: When developmental dysplasia of the hip (DDH) is diagnosed during infancy, conservative management is often successful, with good long-term outcomes. In India, DDH is often not diagnosed until walking age and there are limited guidelines for its screening. Process: A multidisciplinary Expert Group consisting of members of the Paediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association worked collaboratively to develop surveillance guidelines for DDH. Objectives: To enhance the early detection rate of DDH in India through development and implementation of a standardized surveillance care pathway, thus reducing the burden of late-presenting DDH. Recommendations: Routine clinical hip examinations must be performed on all infants at birth and during immunization visits at these approximate time points: 6, 10, and 14 weeks; 6, 9, 12, 15, and 18 months of age. Assessments include Ortolani and Barlow tests for infants <14 weeks; limited hip abduction and leg length discrepancy for infants >14 weeks; and evaluation of limp in walking children. If clinical examination is abnormal or inconclusive, referral to orthopedics for further evaluation and management is recommended. In infants younger than 6 weeks with positive Barlow test but negative Ortolani test, hip ultrasound is recommended at 6 weeks of age. Infants must also be screened for DDH risk factors: breech presentation, family history of DDH, unsafe hip swaddling, and hip instability at any previous clinical examination. In infants with risk factors but normal clinical examination, further evaluation should include ultrasound taken no earlier than 6 weeks of age for infants younger than 14 weeks, ultrasound or X-ray for infants 14 weeks to 6 months of age, and X-ray for infants older than 6 months. Referral to an orthopedic surgeon is recommended if radiological tests are abnormal.