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Use of ultrasonography in developmental dysplasia of the hip
1Section of Pediatric Orthopaedics, Department of Orthopaedics and Traumatology, Faculty of Medicine, Eskişehir Osmangazi University Hospital, 26480, Eskisehir, Turkey, omeroglu.h@gmail.com.
Insights
Ultrasonography effectively screens for developmental dysplasia of the hip (DDH) in infants. Both universal and selective screening programs reduce late diagnoses and surgical interventions for DDH.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
Background:
- Ultrasonography has been a key diagnostic tool for infantile hip dysplasia since the 1980s.
- Several methods exist, including Graf, Harcke, Terjesen, and Suzuki, each with unique classification approaches.
Purpose of the Study:
- To review infantile hip ultrasonography techniques, focusing on the Graf method.
- To evaluate the effectiveness of newborn hip screening programs for developmental dysplasia of the hip (DDH).
Main Methods:
- Comparison of four infantile hip ultrasonography methods: Graf (quantitative), Harcke (qualitative), Terjesen (quantitative/qualitative), and Suzuki (qualitative).
- Assessment of sensitivity and consistency across different ultrasonography techniques.
Main Results:
- The Graf method offers a standardized technique and a well-defined numeric hip typing system.
- No single ultrasonography method has demonstrated clear superiority in sensitivity or consistency.
- Both universal and selective newborn screening programs have shown success in reducing late-detected DDH.
Conclusions:
- Effective ultrasonography requires simple, precise, quantitative, and consistent diagnostic definitions.
- Newborn hip screening, whether universal or selective, significantly reduces late-diagnosed DDH and the need for surgery.
Purpose:
Ultrasonography 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.
Methods:
Several 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.
Results:
Although 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.
Conclusions:
An 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.
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