Developmental Dysplasia of the Hip - a Guideline for Dutch Youth Health Care: abstract

Background and aims. Developmental Dysplasia of the Hip (DDH) is a condition caused by genetic and environmental factors. DDH affects 1-4% of all Dutch children 0-6 months of age. If left untreated, DDH can lead to arthrosis of the hip joint, pain and invalidity. Early detection and treatment are therefore important. Youth Health Care (YHC) professionals have an important role in the early detection of DDH. The aim of the project was to systematically develop a web-based clinical guideline on DDH for YHC professionals. Methods. A working group of various disciplines involved in the screening and treatment of DDH, patients’ representatives, researchers and guideline developers composed the guideline according to the principles of evidence-based medicine. The guideline was piloted in several YHC organizations and implemented nationally in 2017. Results. The guideline provides background information on DDH and its treatment, and statements regarding screening (identification of risk factors, physical examination), referral, communication with caregivers, and cooperation between healthcare providers. The guideline is based on a literature review and practice experience. The following risk factors were identified as indications for diagnostic ultrasound of the hip: positive family history for DDH or hip arthrosis (first or second-degree relatives, below 50 years of age), and breech position during pregnancy or at birth. Anamnesis of swaddling with straight hips and knees, also a risk factor for DDH, is followed by safe swaddling advice by the YHC professional. The YHC physician should perform examination of the hips (abduction, knee height) at least three times in the first 7 months. After the age of 7 months, the YHC physician performs a hip examination in case of caregivers’ report of signals and complaints of their child (case-finding).
Conclusions. In 2017, a systematically developed web-based guideline on DDH was implemented for Dutch YHC professionals. It is expected that this guideline contributes to better quality of healthcare, as it supports evidence-based practice, uniform working procedures, communication with caregivers and cooperation between healthcare providers. Statement or main question. Early treatment of DDH requires screening according to the clinical guideline and appropriate communication with caregivers and between professionals.