A Systematic Review on Neonatal Screening and Orthopaedic Management of Developmental Dysplasia of The Hip Through a Synthesis of Diagnostic Yield and Pavlik Harness Outcomes

Abstract

Background: Developmental dysplasia of the hip (DDH) is a common paediatric orthopaedic condition which affects 1–2 per 1,000 newborns with dislocation; and up to 60 per 1,000 for milder forms detected by ultrasonography. Early identification in the neonatal period allows for conservative treatment - most commonly with the Pavlik harness and reduces the risk of long-term complications such as gait abnormalities and early osteoarthritis.

Objectives: This review evaluates the diagnostic yield of neonatal clinical screening and selective ultrasonography for DDH; and assesses the outcomes of Pavlik harness treatment. Primary metrics include sensitivity, specificity and positive predictive value (PPV) of screening. Additional metrics include treatment success rates, duration, predictors and complications such as avascular necrosis (AVN).

Methodology: A systematic review was conducted using PubMed, Google Scholar and Cochrane databases for studies published between 1990 and 2025. Inclusion criteria targeted primary studies on neonatal DDH diagnosis and Pavlik harness outcomes. Of 342 initially identified records - 295 were screened and nine studies were included following predefined criteria. These comprised three retrospective case series, two prospective cohorts, two retrospective cohorts, one diagnostic test study and one randomized controlled trial.

Results: Clinical screening sensitivity ranged from 18.5% (Choudry & Paton, 2018) to 62% (Mace & Paton, 2015), while specificity consistently exceeded 99%. Sonography improved diagnostic accuracy and influenced management in up to 32% of cases (Ashby & Roposch, 2015). A quality improvement screening bundle (Shen et al., 2023) raised early diagnosis rates from 0.48 to 3.5 per 1,000 and eliminated the need for surgery. Pavlik harness success rates ranged from 46% in older infants (Pollet et al., 2010) to 97.2% in early-treated hips (Gahleitner et al., 2024) - with AVN rates as low as 0% in most successful cohorts.

Conclusion: Ultrasonography significantly enhances diagnostic precision for DDH when paired with clinical screening. The Pavlik harness remains a highly effective and safe intervention - when initiated early in appropriately selected patients. Structured screening protocols and interdisciplinary collaboration between neonatology and orthopaedics are vital to improving outcomes and to reduce the prevalent burden of late-presenting DDH.