Document Type : SYSTEMATIC REVIEW
1 Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
Translational Ocular Research Center, Tehran University of Medical Sciences, Tehran, Iran
Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
Department of Clinical Anatomy, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
Departments of Health Science Research and rthopedics Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
Department of Radiology, Radiology Informatics Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
Background: Developmental dysplasia of the hip (DDH) is a spectrum of diseases involving the femoroacetabular
joint. Due to the controversies over the value of different strategies used for DDH screening, this systematic review
and meta-analysis aimed to assess the diagnostic performance of standard physical examination maneuvers on the
diagnosis of DDH, compared to the Graf ultrasonography (US) method.
Methods: PubMed, Web of Science, and SCOPUS databases were searched until the end of October 2020. Studies
that (i) used the Ortolani test, Barlow test, or limited hip abduction (LHA) test to assess the risk of DDH in physical
examination, (ii)used the Graf US method to examine DDH in sonography, and (iii) provided adequate data to extract
the diagnostic performance were included. Pooled sensitivity and specificity were calculated for clinical examinations.
Results: A total of 25 studies (72,079 patients in total) were considered eligible to enter the present study. The pooled
data of the Ortolani-Barlow test demonstrated a sensitivity of 36% (95% CI:0.25-0.48) and specificity of 98% (95%
CI:0.93-0.99). Calculated pooled sensitivity and specificity for the limited hip abduction exam were obtained at 45%
(95% CI:0.24-0.69) and 78% (95% CI:0.62-0.88) respectively. A separate analysis of the studies using both exams
revealed a sensitivity of 57% (95% CI:0.30-0.82) and a specificity of 95% (95% CI:0.68-0.99).
Conclusion: Based on the results, the investigated clinical examinations have high specificity but low sensitivity to
detect the DDH; therefore, they have limited application as a screening test. If obliged to rely on clinical examinations
for screening, the combination of Ortolani-Barlow and LHA tests can provide more sensitivity than either of these tests
Level of evidence: III