Neonatal screening for developmental dysplasia of the hip Ortolani and Barlow sign accuracy review

Abstract

Introduction: Developmental dysplasia of the hip (DDH) joint is a preventable cause of disability. If detected early, the result is expected to be a complete improvement. Ortolani and Barlow clinical test is performed early to detect DDH. However, the authors have different opinions regarding the accuracy of the Ortolani and Barlow sign and the need for an ultrasound scan (USS) as a screening tool for DDH. Methods: This review involves a comprehensive search on Medline through PubMed and OVID, then from Google Scholar and article references for any paper or clinical trial that studies the accuracy of Ortolani and Barlow sign against the gold standard USS. Results: Four studies have been included. Sensitivity lied between 7% and 28.3%, specificity between 94.5% and 99.8%, positive predictive value (PPV) 13.6%–85.7% and negative predictive value (NPV) 88.4%–97.7%. However, when the clinical examination was repeated more than twice and the USS at 6 months of age was considered the gold standard, sensitivity improved significantly to reach 84%, specificity 82%, PPV 14% and NPV 99%. The relative risk of DDH in patients with positive OB was between 6.11 and 7.4. Discussion: The OB could be considered a risk factor for DDH. It did not show enough sensitivity to be considered a valid screening test for DDH. Low sensitivity and PPV devalue OB for DDH screening. Alternatively, repeated clinical examination improves the test sensitivity and could be adopted in settings where universal USS is not possible due to lack of funds or experience.