Congenital Hip Dysplasia: Sensitivity and Specificity

Introduction: aka Developmental Hip Dysplasia. Screened on well child checks < 1 year of age.

>20% of affected children have a positive family history.

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Prevalence

European ancestry

0.2%

rare in African-Americans

Am Fam Physician. 1999 Jul;60(1):177-84, 187-8. PMID: 10414637

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The sensitivity and specificity of findings for Congenital Hip Dysplasia are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Sensitive and Specific Findings
Finding	Result	Sensitivity	Specificity
[ + ] Limp	+ 0 -	95%	93%
Study: Ann Saudi Med. 2002 Jan-Mar;22(1-2):102-4. PMID: 17259781 http://www.kfshrc.edu.sa/annals/221_222/01-217.pdf
[ + ] Hamstring Stretch Test	+ 0 -	88%	85%
full passive extension of the knee with hip flexed at 90 degrees. Study: Ann Saudi Med. 2002 Jan-Mar;22(1-2):102-4. PMID: 17259781 http://www.kfshrc.edu.sa/annals/221_222/01-217.pdf

Poorly Diagnostic Findings
Finding	Result	Sensitivity	Specificity
[ + ] Limited Hip Abduction in Flexion	+ 0 -	82%	80%
Study: Ann Saudi Med. 2002 Jan-Mar;22(1-2):102-4. PMID: 17259781 http://www.kfshrc.edu.sa/annals/221_222/01-217.pdf
[ + ] Leg Length Discrepancy	+ 0 -	82%	75%
Study: Ann Saudi Med. 2002 Jan-Mar;22(1-2):102-4. PMID: 17259781 http://www.kfshrc.edu.sa/annals/221_222/01-217.pdf

Specific Findings
Finding	Result	Sensitivity	Specificity
[ + ] Ortolani Maneuver	+ 0 -	60%	100%
For the examinations, the infant's hips are flexed to 90 degrees; the thumbs of the examiner are placed on the medial proximal thigh, and the long fingers are placed over the greater trochanter. For the Ortolani maneuver, the contralateral hip is held still while the thigh of the hip being tested is abducted and gently pulled anteriorly. The sensation of instability in a positive Ortolani maneuver is the palpable and sometimes audible "clunk" of the femoral head moving over the posterior rim of the acetabulum and relocating in the cavity. The more poorly developed the acetabulum (and thus the more unstable the hip), the less pronounced the "clunk." Consequently, the Ortolani maneuver must be performed very gently to avoid obscuring the sound of the femoral head passing over a poorly developed posterior acetabulum. Audible high-pitched "clicks" without a sensation of instability have no pathologic significance. This exam have very limited sensitivity in inexperienced hands. Study: D.A. Jones, Neonatal detection of developmental dysplasia of the hip, J Bone Joint Surg 80-B (1998), pp. 943-945. Am Fam Physician. 1999 Jul;60(1):177-84, 187-8. PMID: 10414637
[ + ] Telescoping	+ 0 -	51%	98%
Examiner attempts to dislocate the hip by traction. Study: Ann Saudi Med. 2002 Jan-Mar;22(1-2):102-4. PMID: 17259781 http://www.kfshrc.edu.sa/annals/221_222/01-217.pdf
[ + ] Trendelenburg Sign	+ 0 -	84%	94%
The Trendelenburg sign is said to be positive if, when standing on one leg, the pelvis drops on the side opposite to the stance leg. Study: Ann Saudi Med. 2002 Jan-Mar;22(1-2):102-4. PMID: 17259781 http://www.kfshrc.edu.sa/annals/221_222/01-217.pdf
[ + ] Barlow Maneuver	+ 0 -	52%	94%
For the examinations, the infant's hips are flexed to 90 degrees; the thumbs of the examiner are placed on the medial proximal thigh, and the long fingers are placed over the greater trochanter. The Barlow maneuver is performed by adducting the hip while pushing the thigh posteriorly. If the hip goes out of the socket, it is called "dislocatable" and the test is termed "positive." The dislocation is confirmed by performing the Ortolani maneuver to reduce or relocate the hip. This test has very limited sensitivity in inexperienced hands. Study: Ann Saudi Med. 2002 Jan-Mar;22(1-2):102-4. PMID: 17259781 http://www.kfshrc.edu.sa/annals/221_222/01-217.pdf Am Fam Physician. 1999 Jul;60(1):177-84, 187-8. PMID: 10414637