Missed and Delayed Diagnosis of Developmental Dysplasia of the Hip in the Era of Expanded Screening: A National Analysis From 2013 to 2024.

Abstract

Developmental dysplasia of the hip (DDH) ranges from mild acetabular dysplasia to complete dislocation. Early diagnosis gives the opportunity for nonsurgical management. Delayed detection often necessitates invasive procedures. This study examined recent trends in infant hip ultrasound utilization, DDH incidence, and surgical reduction to assess whether increased imaging has translated into earlier diagnosis and reduced surgical burden. A retrospective cohort study was conducted using the TriNetX Network from 2013 to 2024. ICD and CPT codes identified infants undergoing hip ultrasound within the first 6 months of life. Annual incidence of ultrasound use, DDH diagnosis, and open or closed reductions in children below 5 years was calculated. Analyses were stratified by academic versus nonacademic institutions. Demographic associations with ultrasound utilization were examined using multivariable logistic regression. Among 8,655,956 infants, 135,192 (1.56%) underwent hip ultrasound. Utilization in the United States declined from 0.523% in 2013 to 0.325% in 2017, then rose to 0.543% in 2024. DDH incidence decreased from 0.41% in 2013 to 0.19% in 2020, then increased to 0.28% in 2024. Academic centers reported higher ultrasound utilization and DDH incidence. Open reduction incidence remained low (0.0024% to 0.0032%) but rose slightly after 2018. Closed reductions occurred more often (0.0033% to 0.0044%) and increased modestly post-2018. Female infants had higher odds of ultrasound than males (OR: 1.72; 95% CI: 1.69-1.75; P<0.001). Black (OR: 0.56; 95% CI: 0.55-0.57; P<0.001) and Native American (OR: 0.56; 95% CI: 0.49-0.65; P<0.001) infants had lower odds of ultrasound, while Asian infants had higher odds (OR: 1.23; 95% CI: 1.20-1.27; P<0.001). From 2013 to 2024, the incidence of hip ultrasound utilization and DDH diagnoses initially declined, then rose. Incidence of open and closed reduction also began rising in 2018, suggesting persistent late diagnosis or delays in care despite greater imaging availability. Standardized care pathways, timely orthopaedic referral, and equitable access to imaging are needed to promote early diagnosis that translates into successful nonoperative management. Level III-retrospective cohort.