Hip Sonography: Background; Technique and Common Mistakes; Results; Debate and Politics; Challenges

Graf, Reinhard

doi:10.5301/hipint.5000514

Cited by 66 publications

(74 citation statements)

References 15 publications

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“…However, there are many different techniques in use [3 -6]. The value of US screening is dependent on adherence to correct technique which underlines the critical importance of standardized training, audit and quality control [7].…”

Section: Zusammenfassungmentioning

confidence: 99%

“…The Graf technique correlates the pathology and severity of acetabular dysplasia, with the patient's age, thus offering a patient-specific diagnostic and treatment algorithm [7]. The scanning technique per se is standardized, and its application and principles have been thoroughly described [54].…”

Section: Us Examination Techniquesmentioning

confidence: 99%

“…Mistakes may be avoided by strict adherence to the technique, so only appropriately trained and certified sonographers should be allowed to scan. Continuous quality control and audit should also be offered [7].…”

Section: Us Examination Techniquesmentioning

confidence: 99%

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International Interdisciplinary Consensus Meeting on the Evaluation of Developmental Dysplasia of the Hip

O’Beirne

Chlapoutakis²,

Alshryda³

et al. 2019

Ultraschall in Med

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In September 2018, an international meeting of doctors of various disciplines, with expertise in the detection and treatment of DDH, was held in Csolyospalos, Hungary. The aim was to achieve consensus on the detection and early treatment of the condition and to develop a standardized system of teaching and training for hip ultrasound. There was strong agreement that US screening is essential. Specifically the Graf technique was selected as the technique of choice. Universal US screening was strongly favored. Screening should be carried out as soon as possible, but not later than the sixth week of age. US screening is cost-effective, does not result in overtreatment, and contributes to a reduction of long-term consequences. The essential principle of treatment is timely application of a device to achieve reduction, retention and maturation, by holding the hips in flexion, and a safe degree of abduction. It was agreed that the effectiveness of any screening policy depends on the correct scanning technique. Therefore, standardization of teaching and training of the Graf technique is mandatory. A unified teaching policy and materials should be developed for this purpose. Certification, re-certification and audit were discussed. The group, which has been formalized as the International Interdisciplinary Consensus Committee On DDH Evaluation (ICODE), will continue to meet and work towards establishing international consensus on DDH, standardizing and developing teaching and training of the Graf technique for hip US, and maintaining standards for detection and management.

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Section: Zusammenfassungmentioning

confidence: 99%

Section: Us Examination Techniquesmentioning

confidence: 99%

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International Interdisciplinary Consensus Meeting on the Evaluation of Developmental Dysplasia of the Hip

O’Beirne

Chlapoutakis²,

Alshryda³

et al. 2019

Ultraschall in Med

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“…Clinically, early diagnosis of hip dysplasia is essential for adequate therapy and prevention of later pain symptoms and impairment of mobility. Since 1996, hip sonography according to Graf et al is a well-established screening program for congenital hip dysplasia in Germany and in other European countries [3]. Since implementation of the method, the rate of surgical interventions in children and adolescents due to congenital hip dysplasia has decreased to one fifth of the previous number of surgeries [4].…”

Section: Introductionmentioning

confidence: 99%

Is Prematurity a Protective Factor Against Developmental Dysplasia of the Hip? A Retrospective Analysis of 660 Newborns

et al. 2020

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Purpose In Middle Europe developmental dysplasia of the hip (DDH) has an incidence of up to 5.9 %. The rate of congenital hip dislocation as the worst complication of a growth disorder of the hip is between 1.5 % and 2.5 %. Among known risk factors of DDH are breech position, multiples, foot deformities and family history. The aim of this retrospective study was to investigate prematurity as a risk factor for developmental dysplasia of the hip (DDH). Materials and Methods The hips of 283 infants who were born before the 38th week of gestation or earlier, and those of 377 infants who were born after the 37th week of gestation, none of whom had other risk factors for DDH, were compared using the ultrasound technique according to Graf et al., within the first week after birth. Both hips of all infants were included in the study. Results Surprisingly, the difference in alpha angles between the two groups was statistically extremely significant, favoring the preterm infants. Moreover, we found a physiological curve of alpha angle development with a peak after the 31st week of gestation. The incidence of pathological dysplasia was not significantly different in the two groups. Conclusion Our results suggest that prematurity is not a predisposing factor for DDH, but rather is protective for hip development.

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“…Die Sonografie der Säuglingshüfte nach Graf als generelles Screening besteht in seiner jetzigen Form seit dem Gesundheitsstrukturgesetz 1996 in Deutschland (Österreich 1991, Schweiz 1995) [1]. Im Vergleich zu anderen Ländern ohne Screening hat sich in den deutschsprachigen Ländern die Zahl der sekundären Gelenkverschleiße bzw.…”

Section: Introductionunclassified

Closed Reduction as Therapeutic Gold Standard for Treatment of Congenital Hip Dislocation

et al. 2019

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Background Congenital hip dislocation (luxation) has an incidence of 0.4 – 0.7% and is regarded as a prearthrotic deformity. Thus, if not being diagnosed and treated at a very early age, extensive surgical measures are inevitable in childhood and early adulthood. Methods In the time between 01/2013 and 02/2019 we performed 28 600 hips sonographies in babies as part of general screening measures at U2 or U3. There were 71 instable, dysplastic or dislocated hips diagnosed that were treated by arthrographic, closed reduction. After a hip spica cast was applied, reposition was controlled by MRI, estimating the acetabular head index (ACI), the head coverage index (HCI) as well as the femoral headʼs sphericity or by sonography using the Graf method. Results Overall success rate was 91.6% for primary closed reduction. Patients with primarily irreducible hips were significantly older (p < 0.003) than patients with primarily successful reducible hips. Congenital dislocated hips had significantly higher ACIs (p < 0.001) and HCIs (p = 0.03) as well as significantly less well rounded femoral heads (sphericity; p < 0.001) compared to stable hips. Conclusion Early diagnosis and treatment of congenital dislocated hips by closed reduction is essential for a sufficient and regular maturation of the hips without further surgical interventions.

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Hip Sonography: Background; Technique and Common Mistakes; Results; Debate and Politics; Challenges

Cited by 66 publications

References 15 publications

International Interdisciplinary Consensus Meeting on the Evaluation of Developmental Dysplasia of the Hip

International Interdisciplinary Consensus Meeting on the Evaluation of Developmental Dysplasia of the Hip

Is Prematurity a Protective Factor Against Developmental Dysplasia of the Hip? A Retrospective Analysis of 660 Newborns

Closed Reduction as Therapeutic Gold Standard for Treatment of Congenital Hip Dislocation

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