Ultrasound techniques for the detection of developmental dysplasia of the hip: a systematic review and meta-analysis

Abstract

BACKGROUND: Developmental dysplasia of the hip (DDH) encompasses a broad spectrum of hip pathologies, including femoral or acetabular dysplasia, hip instability, or both. According to the medical literature, ultrasonography is the most reliable diagnostic method for DDH. Several techniques for the assessment of hips in newborns and infants, using ultrasonography, have been described. OBJECTIVE: To compare the accuracy of the Graf technique and other diagnostic techniques for DDH. DESIGN AND SETTING: A systematic review of studies that analyzed ultrasound techniques for the diagnosis of DDH within an evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, and LILACS databases for articles published up to May 5, 2020, relating to studies evaluating the diagnostic accuracy of different ultrasound techniques for diagnosing DDH. The QUADAS 2 tool was used for methodological quality evaluation. RESULTS: All hips were analyzed using the Graf method as a reference standard. The Morin technique had the highest rate of sensitivity, at 81.12-89.47%. The Suzuki and Stress tests showed 100% specificity. The Harcke technique showed a sensibility of 18.21% and specificity of 99.32%. CONCLUSION: All the techniques demonstrated at least one rate (sensibility and specificity) lower than 90.00% when compared to the Graf method. The Morin technique, as evaluated in this systematic review, is recommended after the Graf method because it has the highest sensitivity, especially with the three-pattern classification of 89.47%. REGISTRATION NUMBER: Identifier: CRD42020189686 at the International Prospective Register of Systematic Reviews (identifier: CRD42020189686).

The reality of sonography of the infant hip in Brazil: results and recommendations

“…In a systematic review of DDH conducted by Harper et al [35], the four studies that compared universal ultrasound screening (for all newborns) and selective ultrasound screening concluded that, in the United Kingdom, the former would be more cost-effective than the latter because it would reduce the rates of late detection and surgery. Similar conclusions have been drawn from studies conducted in countries such as Germany, Austria, and Switzerland [33], suggesting that DDH screening in Brazil should be carried out by using the Graf's method in the entire neonatal population. The economic impact of screening programs is multifactorial and requires careful consideration on the part of governments.…”

“…Walter et al [12] carried out a review of 131 studies from 25 countries to assess whether the objective quality criteria established for the Graf's method were met and concluded that only 68 (51.9%) of those studies presented ultrasound images that were considered to have met Graf's criteria. It is noteworthy that in Germany, Austria, and Switzerland, hip ultrasound can be performed only with a special license obtained by completing a course with instructors certified and authorized by Professor Graf or one of his representatives [33].…”

ECAD Study: Evaluating agreement degree among paediatricians in hip dysplasia assessment by Graf ultrasound method

“…Graf method is the most widely used ultrasound static technique for neonatal hip assessment (2,11). It requires standardised imaging and has been accepted by health systems of several European countries.…”

Ultrassonografia na avaliação da displasia do desenvolvimento do quadril

“…2 O ultrassom é um método de imagem confiável para o diagnóstico de DDQ no período neonatal, dentre as vantagens neste tipo de exame: é um procedimento não invasivo e não utiliza radiação ionizante, como desvantagem: é um método operador-dependente. 5 A ultrassonografia para acompanhamento de pacientes com DDQ é feita geralmente até os seis meses de idade. No método ultrassonográfico de Graf é possível avaliar imagens estáticas e dinâmicas e identificar a anatomia do acetábulo, a posição da cabeça do fêmur e a maturação e estabilidade da articulação coxofemoral.…”