Many cases of developmental dysplasia of the hip (DDH) are being detected later than expected, according to new research presented at the American Academy of Pediatrics (AAP) 2025 National Conference in Denver, Colorado. The findings suggest that relying mainly on breech presentation and family history as red flags may leave too many children undiagnosed until the condition is more severe.

Researchers at Kaiser Permanente Los Angeles Medical Center, Los Angeles, reviewed medical records of 437 children with DDH younger than 3 years, nearly 40% of whom were diagnosed after 3 months of age. Among these late cases, 21 children had frank hip dislocations, and almost half of them were not identified until after their first birthday. None of the children with late dislocations had a family history of DDH.

Only 5% of those in the late-dislocation group had breech births compared with 41% of those in the early-diagnosis group, the study found. Late dislocations were nearly 12 times more likely in children born vaginally compared with those delivered by cesarean section.

Black children had nearly nine times higher odds of late DDH diagnosis than White children, even after adjusting for other variables.

More than 80% of children with late dislocations required at least one surgery, and some needed multiple trips to the operating room.

“Every patient with a late dislocation did require some type of surgical intervention, which is not typically the case for a patient with an early dislocation,” said Jeffrey Kessler, MD, senior author of the study and pediatric orthopedic surgeon at Kaiser Permanente Los Angeles Medical Center.

The American Academy of Pediatrics recommends selective ultrasounds for newborns for DH only if a clinician detects signs of hip instability, limited motion, or there are other risk factors like a family history or breech position.

Kessler said the findings should prompt pediatricians and family physicians to be more proactive in screening all newborns. 

“Our data reinforce that the most meaningful shift practitioners can make is adopting a lower threshold of suspicion for DDH,” Kessler said. “A patient with DDH without any instability or dislocation may have an essentially normal exam. This is why universal ultrasound screening is so powerful.”

David Hill, MD, adjunct associate professor of pediatrics at University of North Carolina School of Medicine at Chapel Hill, said the findings highlight an uncomfortable truth about screening gaps.

“I teach this diagnosis as a ‘never-miss’ finding, due to the dramatically improved clinical outcomes for patients whose condition is diagnosed and treated early,” said Hill, who was not involved with the study.

Hill said that while universal ultrasound screening could theoretically eliminate most late diagnoses, its adoption in the US would require significant investment.

“Short of universal hip ultrasound screening, it would be difficult to catch 100% of these cases,” he said. “Could the infrastructure be built to accomplish that goal? With the right resources, it could, as we’ve seen with universal newborn hearing screening.”

Pointing to higher odds of late DDH in Black infants and those delivered vaginally, Kessler said, “These groups should prompt clinicians to be especially cautious, but the bigger message is that broad vigilance remains essential,” he said. “Risk factors help guide suspicion, but imaging should be considered liberally even when they’re absent.”

Hill said confirmatory studies will be key to determining whether this research justifies broader policy change.

For now, Kessler says current screening strategies — often focused on breech births and family history — are not enough to catch all cases. 

“​​While resource limitations in the US may preclude universal screening, what practitioners can do now is lower their suspicion threshold and use imaging more liberally to ensure earlier detection,” Kessler said.

Lara Salahi is a health journalist based in Boston. 

Kessler and Hill reported having no conflicts of interest.