Adherence to developmental dysplasia of the hip screening guidelines among French healthcare providers: A cross-sectional survey

Developmental dysplasia of the hip (DDH) remains a leading cause of early hip morbidity, and its prognosis depends on timely diagnosis and intervention. Since 2013, a nationwide screening program in France has sought to reduce the burden of late-presenting DDH through standardized clinical examination and risk-based ultrasonography. However, disparities in adherence and implementation have been suspected across various medical specialties. We hypothesized that adherence to the guidelines for early diagnosis of developmental dysplasia of the hip differed among practitioners’ groups. A cross-sectional survey was conducted under the auspices of the French Society of Pediatric Orthopedics. A structured online questionnaire, adapted to each specialty, was distributed to general practitioners, community pediatricians, maternity ward pediatricians, pediatric radiologists, and pediatric orthopedic surgeons. Questions assessed clinical experience, practice setting, involvement in DDH screening, knowledge and application of national recommendations, referral patterns, and training. Descriptive statistics were used to summarize responses. Subgroup comparisons were performed using Chi-square or Fisher’s exact tests. A total of 641 respondents participated: 43 general practitioners, 283 community pediatricians, 150 maternity ward pediatricians, 86 pediatric radiologists, and 79 pediatric orthopedic surgeons. While DDH screening was considered a clinical priority by nearly all respondents, substantial variations were observed in adherence to guidelines. Only 48% of general practitioners and 72% of community pediatricians reported full adherence to the national recommendations. Ultrasonography was frequently overused, particularly among pediatricians, often beyond the risk-based indications. Structured referral pathways were lacking in over half of general practitioners and 9% of maternity pediatricians. Notably, 17% of maternity ward pediatricians initiated treatment without prior specialist consultation. Among orthopedic surgeons, 310 DDH cases were diagnosed after 3 months of age, highlighting persistent delays in referral. Undergraduate training was considered insufficient by more than half of the respondents, and postdoctoral training was inconsistently pursued across groups. Despite a well-established national screening framework, DDH diagnosis in France remains fragmented, with inconsistencies in referral practices, overuse of imaging, and gaps in training. Improved interprofessional coordination, standardized referral protocols, and strengthened educational initiatives are urgently needed to reduce late diagnoses and optimize outcomes. IV; Cross-sectional descriptive study.