CFRI investigator Dr. Kishore Mulpuri chaired the working group that developed the new American Academy of Orthopedic Surgeons guidelines for diagnosing and treating developmental dysplasia of the hip (DDH) in infants up to six months of age. DDH is a common condition that can usually be corrected without surgery when diagnosed early. However, until now, health care workers have lacked clear, evidence-based guidelines for screening and treatment.
The guidelines took into account the latest scientific and clinical information, in addition to existing accepted approaches to treatment. The Journal of Bone and Joint Surgery released a summary of the guidelines in October 2015 and the complete guidelines can be found on the American Academy of Orthopedic Surgeons website.
The hip joint is a “ball-and-socket” joint. In hip dysplasia, the “ball,” or femoral head, is loose in the hip socket, or acetabulum, making it unstable and prone to dislocation. DDH is most often present at birth although the condition may develop later on during infancy or early childhood. Recent studies have found five to seven per cent of newborns have hip abnormalities that require intervention.
In infants, a soft harness may be sufficient to keep the hip socket in place, while older children may require surgery. If people born with DDH don’t receive appropriate care early in life, they can suffer from chronic pain and decreased mobility into adulthood. By giving health care workers better tools to diagnose and treat DDH in infants, these guidelines will hopefully lead to earlier, less invasive, more successful treatments.
In some key areas, researchers were unable to make strong recommendations because of a lack of evidence in the existing research. By highlighting these understudied areas, the guidelines also provide scientists with a roadmap for further research. CFRI is leading this initiative by hosting the world’s largest database tracking outcomes of patients with DDH. The CFRI research team is also working on developing improved methods of screening and detection of DDH.
The American Academy of Pediatrics, the Pediatric Orthopaedic Society of North America (POSNA), the Society of Diagnostic Medical Sonography, and the Society for Pediatric Radiology have already endorsed the new guidelines.
Dr. Kishore Mulpuri is a CFRI investigator, a Pediatric Orthopedic Surgeon at BC Children’s Hospital, and an Associate Professor in the Division of Pediatric Orthopedics in the Department of Orthopedics at the University of British Columbia (UBC).
Dr. Mulpuri’s research is made possible by support from the International Hip Dysplasia Institute and BC Children’s Hospital Foundation.
- American Academy of Orthopaedic Surgeons. Detection and nonoperative management of pediatric developmental dysplasia of the hip in infants up to six months of age.
- Mulpuri K,Song KM,Gross RH, Tebor GB, Otsuka NY,Lubicky JP,Szalay EA,Harcke HT,Zehr B,Spooner A,Campos-Outcalt D,Henningsen C,Jevsevar DS,Goldberg M,Brox WT,Shea K,Bozic KJ,Shaffer W,Cummins D,Murray JN, Mohiuddin M,Shores P,Woznica A,Martinez Y, Sevarino K. The American Academy of Orthopaedic Surgeons Evidence-Based Guideline on Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age. Journal of Bone and Joint Surgery. 2015;97(20):1717-1718.
- Mulpuri K, Song KM, Goldberg MJ, Sevarino K. Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age. Journal of the American Academy of Orthopaedic Surgery. 2015;23(3):202-205.