α and β angles used in hip ultrasound Hip ultrasound X-Ray Image showing<unk>  in a baby Most countries have standard newborn exams that include a hip joint exam screening for early detection of<unk> . Sometimes during an exam a "click" or more precisely "clunk" in the hip may be detected (although not all clicks indicate<unk> . When a hip click (also known as "clicky hips" in the UK) is detected, the child's hips are tracked with additional screenings to determine if developmental dysplasia of the hip is caused. Two maneuvers commonly employed for diagnosis in neonatal exams are the Ortolani maneuver and the Barlow maneuver. In order to do the Ortolani maneuver it is recommended that the examiner put the newborn baby in a position in which the contralateral hip is held still while the thigh of the hip being tested is abducted and gently pulled anteriorly. If a "clunk" is heard (the sound of the femoral head moving over the acetabulum), the joint is normal, but absence of the "clunk" sound indicates that the acetabulum is not fully developed. The next method that can be used is called the Barlow maneuver. It is done by adducting the hip while pushing the thigh posteriorly. If the hip goes out of the socket it means it is dislocated, and the newborn has a congenital hip dislocation. The baby is laid on its back for examination by separation of its legs. If a clicking sound can be heard, it indicates that the baby may have a dislocated hip. It is highly recommended that these maneuvers be done when the baby is not fussing, because the baby may inhibit hip movement. Asymmetrical gluteal folds and an apparent limb-length inequality can further indicate unilateral<unk> . Most vexingly, many newborn hips show a certain ligamentous laxity, on the other hand severely malformed joints can appear stable. That is one reason why follow-up exams and developmental monitoring are important. Frequency and methods of routine screenings in children is still in debate however physical examination of newborns followed by appropriate use of hip ultrasound is widely accepted. The Harris hip score (developed by William H. Harris MD, an orthopedist from Massachusetts) is one way to evaluate hip function following surgery. Other scoring methods are based on patients' evaluation like e.g. the Oxford hip score, HOOS and WOMAC score. Children's Hospital Oakland Hip Evaluation Scale (CHOHES) is a modification of the Harris hip score that is currently being evaluated.<unk>  can develop in older age. Adolescents and adults with<unk>  may present with hip pain and in some cases hip labral tears. X-rays are used to confirm a diagnosis of<unk> . CT scans and MRI scans are occasionally used too. Terminology Some sources prefer "developmental dysplasia of the hip" (DDH) to "congenital dislocation of the hip" (CDH), finding the latter term insufficiently flexible in describing the diversity of potential complications. The use of the word congenital can also imply that the condition already exists at birth. This terminology introduces challenges, because the joint in a newborn is formed from cartilage and is still malleable, making the onset difficult to ascertain. The newer term DDH also encompasses occult dysplasia (e.g. an underdeveloped joint) without dislocation and a dislocation developing after the "newborn" phase. The term is not used consistently. In pediatric/neonatal orthopedics it is used to describe unstable/dislocatable hips and poorly developed acetabula. For adults it describes hips showing abnormal femur head or acetabular x-rays. Some sources prefer the term<unk> " over DDH, considering it to be "simpler and more accurate", partly because of the redundancy created by the use of the terms developmental and dysplasia. Types of DDH include subluxation, dysplasia, and dislocation. The main types are the result of either laxity of the supporting capsule or an abnormal acetabulum. Imaging + ACR Appropriateness Criteria for<unk>  Age Scenario Usual appropriate initial imaging 6 months X-ray<unk>  diagnosed by ultrasound and projectional radiography ("X-ray"). Ultrasound imaging is generally preferred at up to 4 months due to limited ossification of the skeleton. Despite the widespread of ultrasound, pelvis X-ray is still frequently used to diagnose or monitor<unk>  or for assessing other congenital conditions or bone tumors. The most useful lines and angles that can be drawn in the pediatric pelvis assessing<unk>  are as follows: Different measurements are used in adults. File:X-ray of measurements on a normal hip.Normal hip. File:X-ray of measurements in<unk> .Hip dysplasia.
Hip dysplasia
Hip dislocation
Radial dysplasia
Cemento-osseous dysplasia
Achondroplasia
Multiple epiphyseal dysplasia
Metaphyseal dysplasia
Dysostosis