P29 International interdisciplinary consensus meeting on evaluation of developmental dysplasia of the hip

There is substantial disagreement about several aspects of Developmental Dysplasia of the Hip (DDH), including its etiology, policies for detection, and treatment. Introduction of hip ultrasound (US) as a diagnostic and screening tool, opened a new era in the field of early diagnosis and effective treatment. In September 2018 an international meeting of medical doctors of various disciplines, with expertise in the detection and treatment of DDH, was held in Csolyospalos, Hungary. The aim was to arrive at a consensus on these topics, to develop a standardized system of teaching and training in hip US, and to work towards the maintenance of quality in all these areas. It was agreed that etiology of the condition is multifactorial; the role of recognized risk factors, in particular breech presentation, female sex and (first degree) family history was recognised. There was strong agreement that clinical examination alone is inadequate, and that screening by US is essential. Specifically Graf’s techinque of hip US was selected as the US technique of choice. Universal US screening was strongly favoured. Screening should be carried out as soon as possible, but not later than the sixth week of age. US screening is cost-effective, does not result in overtreatment, and contributes to substantially reducing long term consequences. Essential principles of treatment consist of timely application of a device to achieve reduction, retention and maturation, by holding the hips in flexion, and a safe degree of abduction. Finally, it was agreed that effectiveness of any screening policy heavily depends on the correct application of the scanning technique, so standardization of teaching and training in Graf’s technique is considered mandatory. A unified teaching policy and materials will be developed for this purpose. Certification, re-certification and audit have been thoroughly discussed. The group, which has been formalized as the International Interdisciplinary Consensus Committee for DDH Evaluation (ICODE), will continue to meet, and work towards establishing international consensus on DDH, towards standardizing and developing teaching and training in the Graf’s technique of hip US, and towards the maintenance of standards in detection and management of DDH.