Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age

Publication Date: March 21, 2022
Last Updated: March 23, 2022

Summary of Recommendations

Universal Ultrasound Screening

Moderate evidence supports not performing universal ultrasound screening of newborn infants. (Moderate)

Evaluation of Infants with Risk Factors for DDH

Strong evidence supports performing an imaging study before 6 months of age in infants with one or more of the following risk factors: breech presentation, family history, or history of clinical instability. (Strong)

Imaging of the Unstable Hip

Limited evidence supports that the practitioner might obtain an ultrasound in infants less than 6 weeks of age with a positive instability examination to guide the decision to initiate brace treatment. (Limited)

Imaging of the Infant Hip

Limited evidence supports the use of an AP pelvis radiograph instead of an ultrasound to assess DDH in infants beginning at 4 months of age. (Limited)

Surveillance After Normal Infant Hip Exam

Moderate evidence supports that a practitioner re-examine infants previously screened as having a normal hip examination on subsequent visits prior to 6 months of age. (Moderate)

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. (Limited)

Treatment of Clinical Instability

Limited evidence supports either immediate or delayed (2-9 weeks) brace treatment for hips with a positive instability exam. (Limited)

Type of Brace for the Unstable Hip

Moderate evidence supports use of the von Rosen splint over Pavlik, Craig, or Frejka splints for initial treatment of an unstable hip. (Moderate)

Monitoring of Patients During Brace Treatment

Limited evidence supports that the practitioner perform serial physical examinations and periodic imaging assessments (ultrasound or radiograph based on age) during management for unstable infant hips. (Limited)

Recommendation Grading




Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age

Authoring Organization

Publication Month/Year

March 21, 2022

Last Updated Month/Year

July 31, 2023

Document Type


Country of Publication


Target Patient Population

Infants up to six months of age with developmental dysplasia of the hip

Target Provider Population

Orthopaedic surgeons, pediatricians and other allied providers

Inclusion Criteria

Male, Female, Infant

Health Care Settings

Ambulatory, Outpatient

Intended Users

Physical therapist, nurse, nurse practitioner, physician, physician assistant


Diagnosis, Assessment and screening, Management

Diseases/Conditions (MeSH)

D000082602 - Developmental Dysplasia of the Hip


dysplasia, hip dysplasia, infant dysplasia

Source Citation

American Academy of Orthopaedic Surgeons EvidenceBased Clinical Practice Guideline for the Detection and Nonoperative Management of Pediatric Dysplasia of the Hip in Infants Up to Six Months of Age. Published March 21, 2022

Supplemental Methodology Resources

Data Supplement, Data Supplement


Number of Source Documents
Literature Search Start Date
January 1, 2014
Literature Search End Date
April 16, 2020