Stable Hip With Ultrasound Imaging Abnormalities
Limited evidence supports observation without a brace for infants with a clinically stable hip with morphologic ultrasound imaging abnormalities.

Rationale

For an infant with a normal physical examination and ultrasound abnormalities, there is limited evidence to support observation without treatment of that infant with serial ultrasound evaluation up to 6 weeks of age. One low-strength study (Wood 2000) evaluated a group of at-risk patients who were evaluated by ultrasound between two and six weeks of age with clinically stable hips showing ultrasonographic abnormalities that were randomized to treatment with Pavlik harness or observation. The two primary outcome measures were the acetabular coverage on ultrasound and acetabular index on radiograph. While acetabular coverage, measured ultrasonographically, improved in both groups, and was statistically better in the splinted group at the final three-month follow-up, there was no difference in acetabular index.

RISKS AND HARMS
The risk of implementing this recommendation is that necessary treatment could be delayed.

2022 UPDATE ADDITIONAL EVIDENCE
1. Burnett, M., Rawlings, E. L., Reddan, T. An audit of referral time frames for ultrasound screening of developmental hip dysplasia in neonates with a normal antenatal clinical examination. Sonography 2018; 2: 61-66

2. Donma, M. M., Dogru, M., Demirkol, M., Ozcaglayan, O., Topcu, B., Ozcaglayan, T. I. K., Gonen, K. A., Nalbantoglu, B., Nalbantoglu, A., Dogru, R., Ulucan, H., Karakoyun, O., Erol, M. F., Guzelant, A. Y., Donma, O. What Is the Important Point Related to Follow-Up Sonographic Evaluation for the Developmental Dysplasia of the Hip?. Journal of Child Science 2017; 1: e123-e126

3. Kim, H. K. W., Beckwith, T., De La Rocha, A., Zepeda, E., Jo, C. H., Sucato, D. Treatment Patterns and Outcomes of Stable Hips in Infants With Ultrasonic Dysplasia. J Am Acad Orthop Surg 2019; 2: 68-74

4. Laborie, L. B., Markestad, T. J., Davidsen, H., Brurås, K. R., Aukland, S. M., Bjørlykke, J. A., Reigstad, H., Indrekvam, K., Lehmann, T. G., Engesæter, I. O., Engesæter, L. B., Rosendahl, K. Selective ultrasound screening for developmental hip dysplasia: Effect on management and late detected cases. A prospective survey during 1991-2006. Pediatr Radiol 2014; 4: 410-424

5. Larson, J. E., Patel, A. R., Weatherford, B., Janicki, J. A. Timing of Pavlik Harness Initiation: Can We Wait?. J Pediatr Orthop 2019; 7: 335-338

6. Tan, S. H. S., Wong, K. L., Lim, A. K. S., Hui, J. H. The earliest timing of ultrasound in screening for developmental dysplasia of the hips. Ultrasonography 2019; 4: 321-326