Diagnostic Performance of Clinical Examination Versus Ultrasonography in the Detection of Developmental Dysplasia of Hip: A Systematic Review and Meta-Analysis

Document Type : SYSTEMATIC REVIEW

Authors

1 1 Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Translational Ocular Research Center, Tehran University of Medical Sciences, Tehran, Iran

3 Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

4 Department of Clinical Anatomy, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

5 Departments of Health Science Research and rthopedics Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

6 Department of Radiology, Radiology Informatics Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

Abstract

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 
performed independently. 
Level of evidence: III

Keywords

References

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The Archives of Bone and Joint Surgery
Volume 10, Issue 5
May 2022
Pages 403-412

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History

  • Receive Date: 30 September 2021
  • Accept Date: 11 November 2021

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