Developmental Dysplasia of the Hip: Clinical Predictors and the Impact of a Screening Protocol

Background Developmental dysplasia of the hip (DDH) includes a spectrum of hip abnormalities that can cause significant functional impairment if not diagnosed early. Currently, no universal consensus exists regarding the optimal screening strategy. In March 2020, a new DDH screening protocol was implemented at a hospital in northern Portugal. This study aimed to assess the prevalence of DDH, identify associated risk factors and physical examination findings, and evaluate clinical practice changes post-protocol. Methodology We conducted a retrospective, observational, cohort study analyzing hip ultrasounds from August 2017 to August 2024 in infants up to 12 months of age. The cohort was divided into Pre-Protocol and Post-Protocol groups. Results The study included 816 infants (402 (49.3%) Pre-Protocol, 414 (50.7%) Post-Protocol), and 38 cases (4.7%) of DDH were identified. Positive Ortolani (odds ratio (OR) = 53.2) and Barlow (OR = 13.2) tests, as well as congenital foot anomalies (OR = 5.4), were significantly associated with DDH. Following protocol implementation, referrals for prematurity decreased significantly (55 (13.7%) vs. 13 (3.1%), p < 0.001), while referrals for breech presentation (142 (35.3%) vs. 182 (44.0%), p = 0.012) and hip click (55 (13.7%) vs. 87 (21.0%), p = 0.006) increased. Conclusions Protocol implementation led to optimized referrals, reducing low-yield screenings for prematurity while increasing detection efforts for breech presentation. However, referrals for hip clicks increased, suggesting a need for further education. Physical examination remains the cornerstone of screening.