Table Info

Table 1.

Screening policy in Greece [9]

Timing of routine examinations	Policies and actions
1st–2nd week (First routine examination)	DDH screening of all neonates, includes: (a) History (looking for risk factors)^*. (b) Clinical examination (includes Barlow and Ortolani maneuvers). • Universal sonographic screening is not recommended.
1st–2nd week (First routine examination)	Depending on the results: (a) Negative clinical examination^ and no risk factors: • Clinical (re-)examination at the age of two (2) months. (b) Negative clinical examination^ and risk factors present: • Perform hip ultrasound at six (6) weeks. i. In case of positive imaging findings: -Refer to a paediatric orthopaedic surgeon. ii. In case of negative imaging findings: -Clinical (re-)examination at the age of two (2) months. (c) Positive clinical examination^**, irrespective of the presence or absence of risk factors: • Refer to a paediatric orthopaedic surgeon. -Use of a triple nappy is not recommended (insufficient evidence to support it, may delay appropriate treatment).
2 months (Second routine examination)	DDH screening of all the infants, includes: (a) History (looking for risk factors)^*. (b) Clinical examination (includes Barlow and Ortolani maneuvers).
2 months (Second routine examination)	Depending on the results: (a) Negative clinical examination^: • Follow up (no intervention). (b) Indicative/suspicious clinical findings (nonspecific findings, including asymmetries or restricted hip abduction, subtle “clicking” of the hip, with negative Barlow or Ortolani maneuvers): • Sonographic examination and/or referral to a paediatric orthopaedic surgeon. (c) Positive clinical examination^: • Referral to a paediatric orthopaedic surgeon.

DDH: developmental dysplasia of the hip; ^* : risk factors include breech presentation, positive family history (1st or 2nd degree relative), female gender, etc., also see Table 2; ^** : mainly based on Barlow and Ortolani maneuvers

Note. Translated from: “Monitoring children’s health in primary health care”. In: Antoniadou-Koumatou I, Panagiotopoloulos T, Attilakos A, editors. Athens: Institute of Child Health, 2015. (https://www.moh.gov.gr/articles/health/dieythynsh-prwtobathmias-frontidas-ygeias/draseis-kai-programmata-agwghs-ygeias/oikogeneiakos-programmatismos/5256-paidiatrikes-kateythynthries-odhgies). Greek.

Declarations

Author contributions

KC: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. SK: Investigation, Writing—original draft, Writing—review & editing. EP and NS: Validation, Writing—review & editing. RD and MR: Writing—original draft, Writing—review & editing, Validation, Supervision. All authors read and approved the submitted version.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publication

Not applicable.

Availability of data and materials

Not applicable.

Funding

Not applicable.

Copyright

References

Agostiniani R, Atti G, Bonforte S, Casini C, Cirillo M, De Pellegrin M, et al. Recommendations for early diagnosis of Developmental Dysplasia of the Hip (DDH): working group intersociety consensus document. Ital J Pediatr. 2020;46:150. [DOI] [PubMed] [PMC]

Bialik V, Bialik GM, Blazer S, Sujov P, Wiener F, Berant M. Developmental dysplasia of the hip: a new approach to incidence. Pediatrics. 1999;103:93–9. [DOI] [PubMed]

Nemeth BA, Narotam V. Developmental dysplasia of the hip. Pediatr Rev. 2012;33:553–61. [DOI] [PubMed]

Engesæter IØ, Lehmann T, Laborie LB, Lie SA, Rosendahl K, Engesæter LB. Total hip replacement in young adults with hip dysplasia: age at diagnosis, previous treatment, quality of life, and validation of diagnoses reported to the Norwegian Arthroplasty Register between 1987 and 2007. Acta Orthop. 2011;82:149−54. [DOI] [PubMed] [PMC]

Biedermann R, Eastwood DM. Universal or selective ultrasound screening for developmental dysplasia of the hip? A discussion of the key issues. J Child Orthop. 2018;12:296−301. [DOI] [PubMed] [PMC]

Shaw BA, Segal LS; SECTION ON ORTHOPAEDICS; Otsuka NY, Schwend RM, Ganley TJ, Herman MJ, Hyman JE, Shaw BA, et al. Evaluation and Referral for Developmental Dysplasia of the Hip in Infants. Pediatrics. 2016;138:e20163107. [DOI] [PubMed]

Graf R. Hip sonography: background; technique and common mistakes; results; debate and politics; challenges. Hip Int. 2017;27:215–9. [DOI] [PubMed]

Tönnis D. General Radiography of the Hip Joint. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. Springer Berlin, Heidelberg; 1987. pp. 100−42. [DOI]

Antoniadou-Koumatou I, Panagiotopoulos T, Attilakos A. Monitoring children’s health in primary health care. Athens: Institute of Child Health; 2015. Greek.

10.

Giannakopoulou C, Aligizakis A, Korakaki E, Velivasakis E, Hatzidaki E, Manoura A, et al. Neonatal screening for developmental dysplasia of the hip on the maternity wards in Crete, Greece. Correlation to risk factors. Clin Exp Obstet Gynecol. 2002;29:148–52. [PubMed]

11.

Dragonas CG, Kottaridou E, Vampertzis T, Abbakr L, Taha N, Manoukian D. Length of treatment and ultrasound timing in infants with developmental dysplasia of the hip. Eur J Orthop Surg Traumatol. 2024;34:1079−86. [DOI] [PubMed]

12.

Kolovos S, Sioutis S, Papakonstantinou ME, Serenidis D, Altsitzioglou P, Karampikas V, et al. Ultrasonographic screening for developmental dysplasia of the hip: the Graf method revisited. Eur J Orthop Surg Traumatol. 2024;34:723−34. [DOI] [PubMed]

13.

Chatziravdeli V, Kazas C, Metaxiotis D, Chatziioannidis I, Mitsiakos G, Diamanti E. Sonographic Hip Angles in Relation to Gestational Age of Neonates. A Prospective, Cohort in the Population of Northern Greece. Arch Bone Jt Surg. 2023;11:197−205. [DOI] [PubMed] [PMC]

14.

Thallinger C, Pospischill R, Ganger R, Radler C, Krall C, Grill F. Long-term results of a nationwide general ultrasound screening system for developmental disorders of the hip: the Austrian hip screening program. J Child Orthop. 2014;8:3−10. [DOI] [PubMed] [PMC]

15.

Tschauner C, Fürntrath F, Saba Y, Berghold A, Radl R. 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;5:415–24. [DOI] [PubMed] [PMC]

16.

von Kries R, Ihme N, Altenhofen L, Niethard FU, Krauspe R, Rückinger S. General Ultrasound Screening Reduces the Rate of First Operative Procedures for Developmental Dysplasia of the Hip: A Case-Control Study. J Pediatr. 2012;160:271–5. [DOI] [PubMed]

17.

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;86:585−9. [PubMed]

18.

O’Beirne JG, Chlapoutakis K, Alshryda S, Aydingoz U, Baumann T, Casini C, et al. International Interdisciplinary Consensus Meeting on the Evaluation of Developmental Dysplasia of the Hip. Ultraschall Med. 2019;40:454–64. [DOI] [PubMed]

19.

Ömeroğlu H, Kapıcıoğlu MİS, Korkusuz F. Newborn hip screening experience in Türkiye. Explor Musculoskeletal Dis. 2024;2:69–74. [DOI]

20.

Ömeroğlu H, Yüksel S, Demir P, Alexiev V, Alsiddiky A, Anticevic D, et al. An Eastern Europe and Middle East multinational expert Delphi consensus study on the prevention, diagnosis, and treatment of developmental dysplasia of the hip before walking age. Int Orthop. 2024;48:1373–80. [DOI] [PubMed]

21.

Westacott DJ, Butler D, Shears E, Cooke SJ, Gaffey A. Universal versus selective ultrasound screening for developmental dysplasia of the hip: a single-centre retrospective cohort study. J Pediatr Orthop B. 2018;27:387–90. [DOI] [PubMed]

22.

Gray J, Toledo A, Haynes J. Is universal ultrasound screening for developmental DDH in newborns better than physical examination screening or selective ultrasound screening? Evidence-Based Practice. 2019;22:15−7. [DOI]