Use of ultrasonography in developmental dysplasia of the hip

Abstract

PurposeUltrasonography has been used as a diagnostic tool in developmental dysplasia of the hip (DDH) during early infancy since the early 1980s. The aim of this review article is to summarise the technique, benefits and shortcomings of four infantile hip ultrasonography methods, focusing mainly on the Graf method, and to assess the effectiveness of ultrasonographic newborn hip screening programmes.MethodsSeveral infantile hip ultrasonography methods have been defined to assess the relationship between the femoral head and acetabulum. The Graf, Harcke, Terjesen and Suzuki methods are the universally known ones. The Graf method is composed of a quantitative classification system, while the Harcke and Suzuki methods have qualitative definitions and the Terjesen method contains both quantitative and qualitative descriptions.ResultsAlthough the results of several studies assessing the sensitivity and consistency of the ultrasonography methods have still not proven a clear dominance of one of these techniques, the primary advantage of the Graf method is that it has a standardised examination technique, as well as a very well defined numeric hip typing system. The importance of newborn hip screening has been universally accepted, but there is still no strong evidence regarding the superiority of either universal (screening of all newborns) or selective (screening of high-risk newborns) ultrasonographic newborn hip screening programmes.ConclusionsAn effective ultrasonographic method should include simple, precise, quantitative and consistent definitions for a proper examination and diagnosis. Both universal and selective ultrasonographic newborn hip screening programmes have significantly decreased the rate of late detected DDH and lessened the need for surgical treatment.

Developmental dysplasia of the hip: What has changed in the last 20 years?

“…It has a central role in the decision making between closed and open reduction [1] . quantitative and consistent definitions for a proper examination and diagnosis, and Graf's method meets all these requirements [69] .…”

“…The most common ones are the Graf, Harcke, Terjesen and Suzuki methods. The Graf method is composed of a quantitative classification system, while the Harcke and Suzuki methods have qualitative definitions, and the Terjesen method contains both quantitative and qualitative descriptions [69] . Studies that compared the reliability and sensitivity of the Terjesen and Graf methods, reached different conclusions [70,71] .…”

Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip

“…Subsequently, treatment of DDH by the Pavlik harness (Pavlik's method) has become the universally preferred treatment method in children younger than 6 months of age [17,28,29]. Hip ultrasonography is a useful tool to follow the course of treatment by the Pavlik harness, besides its early diagnostic aids in DDH [20,29]. When a normal hip sonogram is achieved after Pavlik harness treatment, no considerable difference exists between staged and immediate ending of the treatment regarding outcomes and complications [30].…”

A new sign in the standard hip ultrasound image of the Graf method.

“…The 2 0 angle difference may exert a major repercussion on borderline hips: type IIa-, IIa+ or IIb with alpha angle value close to 60 0 . This category of patients is the main cause for controversial literature data on the increased rate of over-diagnosis [6,12,18,19].…”