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Comparison of morphologic and dynamic US methods in examination of the newborn hip
Pinar Koşar1, Elif Ergun, Dilek Unlübay
1Department of Radiology, Ankara Training and Research Hospital, Turkey.
Insights
Combining morphological and dynamic hip ultrasonography (US) improves developmental dysplasia of the hip (DDH) diagnosis. This approach helps minimize both overtreatment and delayed treatment for infants with DDH.
Area of Science:
- Pediatric Radiology
- Orthopedic Imaging
- Neonatal Musculoskeletal Assessment
Background:
- Developmental dysplasia of the hip (DDH) is a common condition requiring accurate diagnosis.
- Ultrasonography (US) is a primary imaging modality for evaluating the neonatal hip.
- Differentiating normal from abnormal hip findings is crucial for timely intervention.
Purpose of the Study:
- To compare morphologic and dynamic ultrasonography (US) methods for diagnosing developmental dysplasia of the hip (DDH).
- To assess the effectiveness of combined US techniques in classifying hip abnormalities in infants.
Main Methods:
- A total of 6,800 hips in 3,400 infants were examined using Graf's morphological method and Harcke's dynamic method of hip ultrasonography.
- Hips were classified based on the Graf classification system (Types 1-4).
- Dynamic stress maneuvers were applied to specific hip types to assess stability.
Main Results:
- The Graf classification identified 81.47% of hips as Type 1 (normal) and varying percentages for other types, including dysplasia and dislocation.
- Morphological US identified normal relationships in 6,460 hips (Type 1-2c), subluxation in 197 (Type 3), and dislocation in 143 (Type 4).
- Dynamic studies revealed instability in 8.52% of Type 1 and 7.63% of Type 2a hips, with some cases progressing or being reclassified on follow-up.
Conclusions:
- The combined use of morphological and dynamic ultrasonography (US) methods enhances the evaluation of the newborn hip.
- This integrated approach is expected to reduce rates of both overtreatment and delayed treatment for developmental dysplasia of the hip (DDH).
Purpose:
Comparison of morphologic and dynamic methods of hip ultrasonography (US) to differentiate normal from abnormal findings in the diagnosis of developmental dysplasia of the hip (DDH).
Materials And Methods:
A total of 6,800 hips in 3,400 infants were examined with US, using the morphological method of Graf, and the dynamic method of Harcke.
Results:
According to the Graf classification 81.47% of infants had Type 1 (normal hip), 10% Type 2a (physiologic immaturity), 2.44% Type 2b (acetabular dysplasia), 1.05% Type 2c (critical zone hip), 2.89% Type 3 (mildly dislocated), and 2.10% had Type 4 (dislocated) hips. Study in the transverse/neutral plane showed a normal relationship between the femoral head and the acetabulum in the 6,460 hips that were classified as Type 1-2c, that the hip was subluxated in 197 hips of Type 3, and was luxated in 143 hips of Type 4. Dynamic study with stress maneuver of the Type 1-2a hips showed that while 91.48% of the Type 1 hips (n = 5540) were stable and 8.52% were unstable, 92.37% of the Type 2a hips (n = 682) were stable and 7.63% were unstable. Dynamic study was not performed in cases that were diagnosed as Type 2b or worse. Follow-up US showed progression from Type 2a to Type 2b in 2.63% of Type 2a cases. Of the cases, 1.7% that were morphologically normal (Type 1) but unstable in their initial US examination, were revealed to be Type 3 later in the repeat US examination.
Conclusion:
We believe that overtreatment and delayed treatment rates of DDH will be minimized by the use of both morphological and dynamic US methods in the evaluation of the newborn hip.
