International Interdisciplinary Consensus Meeting on the Evaluation of Developmental Dysplasia of the Hip

Joseph Gerard O’Beirne; Konstantinos Chlapoutakis; Sattar Alshryda; Ustun Aydingoz; Thomas Baumann; Carolina Casini; Maurizio de Pellegrin; Gyula Domos; Beat Dubs; Sandeep Hemmadi; Apostolos Karantanas; Stylianos Kolovos; Tanja Kraus; Liang Zhao; Claudia Maizen; Mehrzad Mehdizadeh; Daniel Molitorisz; Thara Persaud; Dimitrios Petratos; Richard Placzek; Sonja Placzek; Sally Scott; Raoul Schmid; Ailbhe Tarrant; Konstantinos Voulgaris

doi:10.1055/a-0924-5491

Ultraschall in der Medizin - European Journal of Ultrasound, Table of Contents

Ultraschall Med 2019; 40(04): 454-464
DOI: 10.1055/a-0924-5491

Guidelines & Recommendations

International Interdisciplinary Consensus Meeting on the Evaluation of Developmental Dysplasia of the Hip

Internationales interdisziplinares Konsensustreffen zur Evaluation der Diagnostik und Therapie der angeborenen Hüftdysplasie

Joseph Gerard O’Beirne

¹Orthopaedics, University-Hospital Waterford, Ireland

,

Konstantinos Chlapoutakis

²Radiology, Vioapeikonisi Imaging Lab, Heraklion, Greece

,

Sattar Alshryda

³Orthopaedics, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates

,

Ustun Aydingoz

⁴Radiology, Hacettepe University School of Medicine, Ankara, Turkey

,

Thomas Baumann

⁵Paediatrics, Solothurn, Switzerland

,

Carolina Casini

⁶Paediatrics, Azienda Ospedaliera Sant’Andrea, Roma, Italy

,

Maurizio de Pellegrin

⁷Orthopaedics, Ospedale San Raffaele, Milano, Italy

,

Gyula Domos

⁸Orthopaedics, Semmelweis Egyetem, Budapest, Hungary

,

Beat Dubs

⁹Internal Medicine, Qualimed Hungary Helathcare Services Kft, Csoylospalos, Hungary

,

Sandeep Hemmadi

¹⁰Orthopaedics, The Noah’s Ark Children’s Hospital for Wales, Cardiff, United Kingdom of Great Britain and Northern Ireland

,

Apostolos Karantanas

¹¹Radiology, University of Crete School of Medicine, Heraklion, Greece

,

Stylianos Kolovos

¹²Orthopaedics, General Hospital Larissa, Thessaly, Greece

,

Tanja Kraus

¹³Orthopaedics, Medizinische Universität Graz, Austria

,

Liang Zhao

¹⁴Orthopedic Surgery, LinYi Traditional Chinese Medicine Hospital, Lin’yi, China

,

Claudia Maizen

¹⁵Orthopaedics, Royal London Hospital, London, United Kingdom of Great Britain and Northern Ireland

,

Mehrzad Mehdizadeh

¹⁶Radiology, Tehran Medical University, Tehran, Iran (the Islamic Republic of)

,

Daniel Molitorisz

¹⁷Orthopaedics, Paediatric Trauma, Budapest, Hungary

,

Thara Persaud

¹⁸Radiology, Children’s Health at Tallaght, Dublin, Ireland

,

Dimitrios Petratos

¹⁹Orthopaedics, Mitera-Hospital, Athens, Greece

,

Richard Placzek

²⁰Clinic for Orthopaedics and Trauma Surgery, University-Hospital Bonn, Germany

,

Sonja Placzek

²¹Orthopaedics, Medizinischer Dienst der Krankenversicherung Nordrhein, Düsseldorf, Germany

,

Sally Scott

²²Radiology, Dorset-County-Hospital NHS Foundation Trust, Dorchester, United Kingdom of Great Britain and Northern Ireland

,

Raoul Schmid

²³Paediatrics, Paediatrics, Baar, Switzerland

,

Ailbhe Tarrant

²⁴Radiology, Rotunda-Hospital, Dublin, Ireland

,

Konstantinos Voulgaris

²⁵Radiology, Agios Therissos Medical Diagnostic Center, Nicosia, Cyprus

› Author Affiliations

Abstract

In September 2018, an international meeting of doctors of various disciplines, with expertise in the detection and treatment of DDH, was held in Csolyospalos, Hungary. The aim was to achieve consensus on the detection and early treatment of the condition and to develop a standardized system of teaching and training for hip ultrasound. There was strong agreement that US screening is essential. Specifically the Graf technique was selected as the technique of choice. Universal US screening was strongly favored. Screening should be carried out as soon as possible, but not later than the sixth week of age. US screening is cost-effective, does not result in overtreatment, and contributes to a reduction of long-term consequences. The essential principle of treatment is timely application of a device to achieve reduction, retention and maturation, by holding the hips in flexion, and a safe degree of abduction. It was agreed that the effectiveness of any screening policy depends on the correct scanning technique. Therefore, standardization of teaching and training of the Graf technique is mandatory. A unified teaching policy and materials should be developed for this purpose. Certification, re-certification and audit were discussed. The group, which has been formalized as the International Interdisciplinary Consensus Committee On DDH Evaluation (ICODE), will continue to meet and work towards establishing international consensus on DDH, standardizing and developing teaching and training of the Graf technique for hip US, and maintaining standards for detection and management.

Zusammenfassung

Im September 2018 fand in Csolyospalos, Ungarn, ein internationales Treffen von Fachärzten unterschiedlicher Disziplinen mit Expertise in der Diagnostik und Behandlung von DDH statt. Ziel war das Erreichen eines Konsenses zu den einzelnen Aspekten der DDH, die Entwicklung eines standardisierten Lehr- und Trainingssystems für die Anwendung von Hüftultraschall (US) sowie die Sicherung der Anwendungsqualität. Ein starker Konsens bestand darin, dass die klinische Untersuchung alleine unzureichend und eine Ultraschalluntersuchung unerlässlich ist. Die Methodik nach Graf wurde dabei als erste Wahl konsentiert. Ein möglichst vor der sechsten Lebenswoche durchgeführtes generelles US-Screening wurde stark favorisiert. Wesentliches Prinzip der US-gesteuerten Therapie ist dabei der möglichst frühe Behandlungsbeginn zur Reposition bzw. Retention und Nachreifung. Konsens bestand darin, dass die Effektivität eines Screenings stark von der korrekten Anwendung der Scan-Technik abhängt, weswegen eine standardisierte Ausbildung in der Methode nach Graf unerlässlich ist. Korrekt angewendet ist US kosteneffektiv, führt nicht zu Übertherapie und hilft, langfristige Folgen der DDH erheblich zu reduzieren. Daher sollen ein einheitlicher Lehrkatalog und Ausbildungsmaterialien entwickelt werden. Auch eine Zertifizierung, Re-Zertifizierung und mögliche Audits wurden eingehend diskutiert. Die Aufgabe des internationalen, interdisziplinaren Konsensuskomitees fur DDH Evaluation (ICODE) ist es, einen internationalen Konsens über Diagnostik- und Behandlungsstandards der DDH herzustellen sowie einen internationalen, standardisierten Lehr- und Ausbildungsplan in der Methodik nach Graf zu entwickeln und zu etablieren.

Key words

education - training - quality assurance - musculoskeletal system - pediatrics

Full Text

References

References
1 Fujii M, Nakashima Y, Jingushi S. et al. Intraarticular findings in symptomatic developmental dysplasia of the hip. J Pediatr Orthop 2009; 29: 9-13
2 Reijman M, Hazes J, Pols H. et al. Acetabular dysplasia predicts incident osteoarthritis of the hip: the Rotterdam study. Arthritis Rheum 2005; 52: 787-793
3 Graf R. The diagnosis of congenital hip joint dislocation by ultrasound compound treatment. Arch Orthop Trauma Surg 1980; 97: 117-133
4 Terjesen T, Bredland T, Berg V. Ultrasound for hip assessment in the newborn. J Bone Joint Surg [Br] 1989; 71-B: 767-773
5 Morin C, Harcke H, MacEwen G. The infant hip: real time US assessment of acetabular development. Radiology 1985; 157: 673-677
6 Suzuki S, Kasahara Y, Futami T. et al. Ultrasonography in congenital dislocation of the hip: simultaneous imaging of both hips from in front. Bone Joint Surg 1991; 73-B: 879-883
7 Graf R. Hip sonography: background; technique and common mistakes; result; debate and politics; challenges. Hip Int 2017; 27: 215-219
8 Oxford Living Dictionaries. Oxford Living Dictionaries. [Internet]. Available from: https://en.oxforddictionaries.com/definition/dysplasia
9 American Academy of Orthopedic Surgeons (AAOS). Advisory Statement. “CDH” should be “DDH”. 1991
10 Dezateux C, Rosendahl K. Developmental dysplasia of the hip. Lancet 2007; 369: 1541-1552
11 Shipman S, Helfand M, Moyer V. et al. Screening for developmental dysplasia of the hip: A systematic literature review for the U. S. Preventive Services Task Force. Pediatrics 2006; 117: e557-e576
12 Alshryda S, Jones S, Banaszkiewicz P. Postgraduate Paediatric Orthopaedics: The Candidate’s Guide to the FRCS (Tr and Orth) Examination. Cambridge: Cambridge University Press; 2014
13 Herring J. Tachdjian’s Pediatric Orthopaedics: From the Texas Scottish Rite Hospital for Children. 5th. ed Philadelphia: Saunders Elsevier; 2013
14 Koureas G, Wicart P. Etiology of Developmental Hip Dysplasia or Dislocation. Hip International 2007; 17 (Suppl. 05) S1-S7
15 Carter C, Wilkinson J. Genetic and environmental factors in the etiology of congenital dislocation of the hip. Clin Orthop Relat Res 1964; 33: 119-128
16 Browne D. Congenital deformities of mechanical origin. Arch Dis Child 1955; 30: 37-41
17 Dunn P. Perinatal observations on the etiology of C.D.H. Clin Orthop 1976; 119: 11-22
18 Ortiz-Neira C, Paolucci E, Donnon T. A meta-analysis of common risk factors associated with the diagnosis of developmental dysplasia of the hip in newborns. European Journal of Radiology 2012; 81: e344-e351
19 Seringe R, Bonnet J, Katti E. Pathogeny and natural history of congenital dislocation of the hip. Orthopaedics & Traumatology: Surgery & Research 2014; 100: 59-67
20 De Pellegrin M, Moharamzadeh D. Developmental dysplasia of the hip in twins: the importance of mechanical factors in the etiology of DDH. J Pediatr Orthop 2010; 30: 774-778
21 MacFarlane A. Congenital dislocation of the hip – an epidemiological conundrum. Maternal and Child Health Journal 1980; 5: 13-15
22 Lehmann H, Hinton R, Morello P. et al. Developmental dysplasia of the hip practice guideline: technical report. Committee on Quality Improvement, and Subcommittee on Developmental Dysplasia of the Hip. Pediatrics 2000; 105: E57
23 Bialik V, Bialik G, Blazer S. et al. Developmental dysplasia of the hip: a new approach to incidence. Pediatrics 1999; 103: 93-99
24 Loder R, Skopelja E. The epidemiology and demographics of hip dysplasia. ISRN Orthop 2011; 2011: 238607
25 De Hundt M, Vlemmix F, Bais J. et al. Risk factors for developmental dysplasia of the hip: a meta-analysis. European Journal of Obstetrics & Gynaecology and Reproductive Biology 2012; 165: 8-17
26 Paton R, Hinduja K, Thomas C. The significance of at-risk factors in ultrasound surveillance of developmental dysplasia of the hip. J Bone Joint Surg [Br] 2005; 87-B: 1264-1266
27 Clarke N, Reading I, Corbin C. et al. Twenty years experience of selective secondary ultrasound screening for congenital dislocation of the hip. Arch Dis Child 2012; 97: 423-429
28 Perry D, Tawfik S, Roche A. et al. The association between clubfoot and developmental dysplasia of the hip. J Bone Joint Surg [Br] 2010; 92-B: 1586-1588
29 Shaw B, Segal L. Evaluation and referral for developmental dysplasia of the hip in infants. Pediatrics 2016; 138: e20163107
30 Standing Medical Advisory Committee. Screening for the detection of congenital dislocation of the hip. Arch Dis Child 1986; 61: 921-926
31 Graf R. Classification of hip joint dysplasia by means of sonography. Arch Orthop Trauma Surg 1984; 102: 248-255
32 Clarke N, Harcke H, McHugh P. et al. Real-time ultrasound in the diagnosis of congenital dislocation and dysplasia of the hip. J Bone Joint Surg [Br] 1985; 67: 406-412
33 Wood M, Conboy V, Benson M. Does early treatment by abduction splintage improve the development of dysplastic but stable neonatal hips?. J Pediatr Orthop 2000; 20: 302-305
34 Engesaeter L, Wilson D, Nag D. et al. Ultrasound and congenital dislocation of the hip. The importance of dynamic assessment. J Bone Joint Surg [Br] 1990; 72: 197-201
35 Gardiner H, Dunn P. Controlled trial of immediate splinting versus ultrasonographic surveillance in congenitally dislocatable hips. Lancet 1990; 336: 1553-1556
36 Alshryda S, Huntley J, Banaszkiewicz P. Paediatric Orthopaedics: An Evidence-Based Approach to Clinical Questions. Springer International Publishing; 2017
37 Paton R, Srinivasan M, Shah B. et al. Ultrasound screening for hips at risk in developmental dysplasia. Is it worth it? J Bone Joint Surg [Br] 1999; 81: 255-258
38 Paton R, Choudry Q. Neonatal foot deformities and their relationship to developmental dysplasia of the hip: an 11-year prospective, longitudinal observational study. J Bone Joint Surg [Br] 2009; 91: 655-658
39 Paton R. Screening for hip abnormality in the neonate. Early Hum Dev 2005; 81: 803-806
40 Jari S, Paton R, Srinivasan M. Unilateral limitation of abduction of the hip. A valuable clinical sign for DDH?. J Bone Joint Surg [Br] 2002; 84: 104-107
41 Graf R. Hip Sonography. 2nd. ed. Berlin Heidelberg: Springer-Verlag; 2006
42 Fleissner P, Ciccarelli C, Eilert R. et al. The success of closed reduction in the treatment of complex developmental dislocation of the hip. J Pediatr Orthop 1994; 14: 631-635
43 Abril J, Berjano P, Díaz A. Concordance between hip ultrasonography and hip arthrography in the assessment of developmental dysplasia of the hip. J Pediatr Orthop B 1999; 8: 264-267
44 Placzek R, Funk J, Druschel C. Congenital hip dysplasia in newborns: Clinical and ultrasound examination, arthrography and closed reduction. Oper Orthop Traumatol 2013; 25: 417-429
45 Starr V, Ha B. Imaging Update on Developmental Dysplasia of the Hip With the Role of MRI. Am J Roengenol 2014; 203: 1324-1335
46 Diaz A, Cuervo M, Epeldegui T. Simultaneous Ultrasound Studies of Developmental Dysplasia of the Hip Using the Graf, Harcke, and Suzuki Approaches. Journal of Pediatric Orthopaedics B 1994; 3: 185-189
47 Czubak J, Kotwicki T, Ponitek T. et al. Ultrasound measurements of the newborn hip. Comparison of two methods in 657 newborns. Acta Orthop Scand 1998; 69: 21-24
48 Langford S, New S, Patel K. Comparison of Two Techniques Used in the Assessment/Measurement of Developmental Dysplasia of the Hip (DDH). Ultrasound 2001; 9: 26-30
49 Falliner A, Schwinzer D, Hahne H. et al. Comparing ultrasound measurements of neonatal hips using the methods of Graf and Terjesen. J Bone Joint Surg [Br] 2006; 88: 104-106
50 Peterlein C, Schüttler K, Lakemeier S. et al. Reproducibility of different screening classifications in ultrasonography of the newborn hip. BMC Pediatr 2010; 10: 98
51 Pacheco E, Bronzatto E, Martins G. et al. EPOS – European Society of Radiology [Internet]. 2012
52 Kotlarsky P, Haber R, Bialik V. et al. Developmental dysplasia of the hip: What has changed in the last 20 years?. World Journal of Orthopedics 2015; 6: 886-901
53 Chlapoutakis K, Kolovos S, Casini C. Ultrasonography in developmental dysplasia of the hip: a review of current clinical strategies and recommendations for revision of practice. Hellenic Journal of Radiology 2017; 2: 36-46
54 Graf R, Lercher K, Scott S. et al. Essentials of Infant Hip Sonopgraphy according to Graf. Stolzalpe Sonocenter; 2017
55 Shirai Y, Wakabayashi K, Wada I. et al. Reproducibility of acquiring ultrasonographic hip images by the Graf method after an infant hip ultrasound training course. J Med Ultrason 2018; 45: 583-589
56 Tschauner C, Fürntrath F, Saba Y. et al. Developmental dysplasia of the hip: impact of sonographic newborn hip screening on the outcome of early treated decentered hip joints-a single center retrospective comparative cohort study based on Graf’s method of hip ultrasonography. J Child Orthop 2011; 5: 415-424
57 Price K, Dove R, Hunter J. Current screening recommendations for developmental dysplasia of the hip may lead to an increase in open reduction. Bone Joint J 2013; 95-B: 846-850
58 Omeroglu H, Kose N, Akceylan A. Success of Pavlik harness treatment decreases in patients ≥ 4 months and in ultrasonographically dislocated hips in developmental dysplasia of the hip. Clin Orthop Relat Res 2016; 474: 1146-1152
59 Phelan N, Thoren J, Fox C. et al. Developmental dysplasia of the hip: incidence and treatment outcomes in the Southeast of Ireland. Irish Journal of Medical Science 2015; 184: 411-415
60 Roovers E, Boere-Boonekamp M, Castelein R. et al. Effectiveness of ultrasound screening for developmental dyplasia of the hip. Arch Dis Child Fetal Neonatal Ed 2005; 90: F25-F30
61 Grill F, Müller D. Ergebnisse des Hüftultraschall-Screenings in Österreich. Orthopäde 1997; 26: 25-32
62 Graf R. Hüftsonografie – ein update. Orthopäde 2002; 31: 181-189
63 Schilt M. Optimaler Zeitpunkt des Hüftsonografie-Screenings. Ultraschall in Med 2001; 22: 39-47
64 Schilt M. Die Hüftsonografie nach Graf bei Neugeborenen und Säuglingen. Schweiz Med Forum 2008; 8: 942-945
65 Farr S. Wann ist der optimale Zeitpunkt für ein sonografisches Hüftscreening?. Orthopäde 2008; 37: 532-540
66 Tyagi R, Zgoda M, Short R. Targeted screening of hIp dysplasia in newborns: experience at a district general hospital in Scotland. Orthop Rev (Pavia) 2016; 8: 6640
67 Bache C, Clegg J, Herron M. Risk factors for developmental dysplasia of the hip in the neonatal period. Journal of Pediatric Orthopaedics 2002; 11: 212-221
68 Imrie M, Scott V, Stearns P. et al. Is ultrasound screening for DDH in babies born breech sufficient?. J Child Orthop 2010; 4: 3-8
69 Kolb A, Schweiger N, Mailath-Pokomy M. et al. Low incidence of early developmental dysplasia in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors. Int Orthop 2016; 40: 123-127
70 Schaeffer E, Mulpuri K. Developmental dysplasia of the hip: addressing evidence gaps with a multicentre prospective international study. Med J Aust 2018; 208: 359-364
71 Choudry Q, Goyal R, Paton R. Is limitation of hip abduction a useful clinical sign in the diagnosis of developmental dysplasia of the hip?. Arch Dis Child 2013; 98: 862-866
72 Pillai A, Joseph J, McAuley A. et al. Diagnostic accuracy of static Graf technique of ultrasound evaluation of infant hips for developmental dysplasia. Arch Orthop Trauma Surg 2001; 131: 53-58
73 American Academy of Orthopaedic Surgeons (AAOS). Guideline Central. [Internet]. 2014
74 Patel H. Preventative health care, 2001 update: screening and management of developmental dysplasia of the hip in newborns. CMAJ 2001; 164: 1669-1677
75 Shorter D, Hong T, Osborn D. Screening programmes for developmental dysplasia of the hip in newborn infants. Cochrane Database of Systematic Reviews 2011; 9: CD004595
76 Shorter D, Hong T, Osborn D. Health CrSpfddothiniEBC, 11-54 8. Cochrane review: Screening programmes for developmental dysplasia of the hip in newborn infants. Evid Based Child Health 2013; 8: 11-54
77 Holen K, Tegnander A, Bredland T. et al. Universal or selective screening of the neonatal hip using ultrasound?. Bone & Joint Journal 2002; 84: 886-890
78 Mahan S, Katz J, Kim Y. To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Joint Surg [Am] 2009; 91-A: 1705-1719
79 Laborie L, Markestad T, Davidsen H. et al. Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective survey during 1999-2006. Paediatr Radiol 2014; 44: 410-424
80 Leba T, Carmichael K, Patton A. et al. Ultrasound for infants at risk for developmental dysplasia of the hip. Orthopedics 2015; 38: e722-e726
81 Sanghrajka A, Murnaghan C, Shekkeris A. et al. Open reduction for developmental dysplasia of the hip: failures of screening or failures of treatment?. The Annals of The Royal College of Surgeons of England 2013; 95: 113-117
82 Sink E, Ricciardi B, Torre K. et al. Selective ultrasound screening is inadequate to identify patients who present with symptomatic adult acetabular dysplasia. Journal of Children’s Orthopaedics 2014; 8: 451-455
83 Marks D, Clegg J, Al-Chalabi A. Routine ultrasound screening for neonatal hip instability. Can it abolish late-presenting congenital dislocation of the hip?. J Bone Joint Surg [Br] 1994; 76-B: 534-538
84 Clegg J, Bache C, Raut V. Financial justification for routine ultrasound screening of the neonatal hip. J Bone Joint Surg [Br] 1999; 81-B: 852-857
85 Wirth T, Stratmann L, Hinrichs F. Evolution of late presenting developmental dysplasia of the hip and associated surgical procedures after 14 years of neonatal ultrasound screening. J Bone Joint Surg [Br] 2004; 86: 585-589
86 Von Kries R, Ihme N, Altenhofen L. et al. General ultrasound screening reduces the rate of first operative procedures for developmental dysplasia of the hip: a case control study. J Paediatr 2012; 160: 271-275
87 Thalinger C, Pospischill R, Ganger R. et al. Long-term results of a nationwide general ultrasound screening system for developlental disorders of the hip: the Austrian hip screening program. J Child Orthop 2014; 8: 3-10
88 Guler O, Seker A, Mutlu S. et al. Results of a universal hip screening program at a single institution. Acta Orthop Traumatol Turc 2016; 50: 42-48
89 Munkhuu B, Essig S, Renchinnyam E. et al. Incidence and treatment of developmental hip dysplasia in Mongolia: a prospective cohort study. PloS One 2013; 8: e79427 . doi:10.1371/journal.pone.0079427
90 Baumann T, Munkhuu B, Chuluunbaatar B. et al. 4-year follow-up of ultrasound-based diagnosis and non-surgical treatment of developmental dysplasia of the hip in Mongolia: a prospective cohort study. Ultraschall in der Medizin – European Journal of Ultrasound 2016; 37 (Suppl. 01) SL3_2
91 Baumann T. SMOPP-Team. ABCD of DDH. SMOPP/SVUPP; 2017 1st ed.
92 Ihme N, Altenhofen L, von Kries R. et al. Orthopäde SHiD, 3. Sonografisches Hüftscreening in Deutschland. Orthopäde 2008; 37: 541-549
93 Paton R, Hossain S, Eccles K. Eight-year prospective targeted ultrasound screening program for instability and at-risk hip joints in developmental dysplasia of the hip. Journal of Pediatric Orthopaedics 2002; 22: 338-341
94 Elbourne D, Dezateux C, Arthur R. et al. Ultrasonography in the diagnosis and management of developmental hip dysplasia (UK Hip Trial): clinical and economic results of a multicentre randomised controlled trial. Lancet 2002; 360: 2009-2017
95 Gray A, Elbourne D, Dezateux C. et al. Economic evaluation of ultrasonography in the diagnosis and management of developmental hip dysplasia in the United Kingdom and Ireland. J Bone Joint Surg [Br] 2005; 87-A: 2472-2479
96 Thaler M, Biedermann R, Lair J. et al. Cost- effectiveness of universal screening compared with clinical examination alone in the diagnosis and treatment of neonatal hip dysplasia in Austria. J Bone Joint Surg [Br] 2011; 93-B: 1126-1130
97 Graf R, Mohajer M, Plattner F. Hip sonography update. Quality management, catastrophes – tips and tricks. Med Ultrason 2013; 15: 299-303
98 Biedermann R, Eastwood D. Universal or selective ultrasound screening for developmental dysplasia of the hip? A discussion of the key isues. J Child Orthop 2018; 12: 296-301
99 Laborie L, Engesaeter I, Lehmann T. et al. Screening strategies for hip dysplasia: long term outcome of a randomised controlled trial. Pediatrics 2013; 132: 492-501
100 Pavlik A. The functional method of treatment using a harness with stirrups as the primary method of conservative therapy for infants with congenital dislodation of the hip. Clin Orthop Relat Res 1957; 1992: 4-10
101 Cashman J, Round J, Taylor G. et al. The natural history of developmental dysplasia of the hip after early supervised treatment in the Pavlik harness. A prospective longitudinal follow-up. J Bone Joint Surg [Br] 2002; 84: 418-425
102 Murnaghan M, Browne R, Sucato D. et al. Femoral nerve palsy in Pavlik harness treatment for developmental dysplasia of the hip. J Bone Joint Surg Am 2011; 93: 493-499
103 Lauge-Pedersen H, Gustafsson J, Hagglund G. 6 weeks with the Von Rosen splint is sufficient treatment of neonatal hip instability. Acta Orthopaedics 2006; 77: 257-261
104 Kilsic P. Congenital dislocation of the hip: a misleading term. J Bone Joint Surg 1984; 71B: 136
105 Talbot C, Paton R. Screening of selected risk factors in developmental dysplasia of the hip: an observational study. Arch Dis Child 2013; 98: 692-696