This is the 2014 AAOS evidence-based clinical practice guideline for detecting and nonoperatively managing DDH in infants up to 6 months of age. It produced nine recommendations from a systematic review of 3,990 citations, only 42 of which met inclusion criteria. The guideline addresses screening indications, imaging choice, bracing timing, and brace selection.
The key number from this guideline is 90%: nearly all ultrasound-detected DDH abnormalities resolve on their own. This is why the guideline pushes back against universal screening and routine bracing of stable hips — the risk of overtreating self-resolving laxity is real.
In practice, this means your imaging and treatment threshold is driven by three specific risk factors: breech presentation, family history, or a clinically unstable exam. No other risk factors reach Moderate evidence. Infant sex no longer qualifies.
When you do identify instability, brace treatment can start immediately or be deferred up to 9 weeks. There is no evidence-based mandate to brace on the first visit. At 4 months, swap ultrasound for AP pelvis radiograph as your primary imaging tool.
For stable hips with ultrasound morphologic abnormalities only, observe without bracing and re-examine before 6 months. The guideline's own authors acknowledge that the evidence supporting every one of these decisions is limited, so clinical judgment and shared decision-making carry significant weight here.
This is the 2014 AAOS evidence-based clinical practice guideline for detecting and nonoperatively managing DDH in infants up to 6 months of age. It produced nine recommendations from a systematic review of 3,990 citations, only 42 of which met inclusion criteria. The guideline addresses screening indications, imaging choice, bracing timing, and brace selection.
The key number from this guideline is 90%: nearly all ultrasound-detected DDH abnormalities resolve on their own. This is why the guideline pushes back against universal screening and routine bracing of stable hips — the risk of overtreating self-resolving laxity is real.
In practice, this means your imaging and treatment threshold is driven by three specific risk factors: breech presentation, family history, or a clinically unstable exam. No other risk factors reach Moderate evidence. Infant sex no longer qualifies.
When you do identify instability, brace treatment can start immediately or be deferred up to 9 weeks. There is no evidence-based mandate to brace on the first visit. At 4 months, swap ultrasound for AP pelvis radiograph as your primary imaging tool.
For stable hips with ultrasound morphologic abnormalities only, observe without bracing and re-examine before 6 months. The guideline's own authors acknowledge that the evidence supporting every one of these decisions is limited, so clinical judgment and shared decision-making carry significant weight here.