Agreement between physical examination and dynamic sonography in infants with developmental dysplasia of the hip

Objective: For years, physical examination (PE) findings (e.g., Barlow, Ortolani tests, and abduction limitation) have been used as the primary screening method in the early diagnosis of developmental dysplasia of the hip (DDH). There are a limited number of studies in the literature that evaluate the agreement of PE findings and dynamic sonographic evaluation. Our aim was to evaluate the correlation between dynamic sonographic hip types and physical examination findings in infants with DDH.

Methods: A total of 281 infants (562 hips) with DDH younger than 6 months who were given Pavlik harness treatment were included in the study. Socio-demographic characteristics (e.g., age, gender, and race) of the infants were recorded. The concordance between the PE findings and sonographic findings of the patients at the first admission was evaluated. The agreement analysis between the dynamic sonography evaluations and the PE results was demonstrated by Cohen’s kappa (k) coe!cient and Kendall’s coe!cient (W) of concordance.

Results: Of the 55 hips evaluated as normal in PE, 21 were normal, 25 were found to have dysplasia, and 9 were subluxated/or subluxatable on dynamic sonography. It was observed that 30 (13%) of 219 hips which were dislocated on dynamic sonography were found to be lax on the PE. The overall percentage of agreement between the physical examination and dynamic sonography was 72.4. The Cohen kappa for agreement between the PE and dynamic sonography was 0.541 (CI: 0.479-0.602). The agreement between Ortolani test evaluation with PE and Ortolani test evaluation of patients diagnosed with dislocated hip by dynamic sonography was 70.3% (Cl: 0.34 (0.22-0.46)), while the agreement of Barlow test was 78.5% (CI: 0-0.26). The Kendall’s coe!cient of concordance between reducible hip (Ortolani positive) under dynamic sonography and PE was 0.546. Dynamic sonographic evaluation of 238 hips with restricted hip abduction showed that 78 (32.7%) were subluxated at rest and/or subluxated with stress, and the remaining 150 (67.3%) hips were dislocated at rest or dislocated with stress.

Conclusion: The agreement between PE and dynamic sonography was fair to moderate. The clinicians should focus on both examinations to reveal essential data for diagnosing and monitoring infants with DDH.

Level of Evidence: Level IV, Diagnostic Study

Cite this article as: Imerci A, Thacker M, I, Bowen R. Agreement between physical examination and dynamic sonography in infants with developmental dysplasia of the hip. Acta Orthop Traumatol Turc., 2025;59(1):45-48.