Normal variation of infant hip development : patterns revealed by 3D ultrasound

Studies of infant hip development to date have been limited by considering only the changes in appearance of a single ultrasound slice (Graf's standard plane). We used 3D ultrasound (3DUS) to establish maturation curves of normal infant hip development, quantifying variation by age, sex, side, and anteroposterior location in the hip.

We analyzed 3DUS scans of 519 infants (mean age 64 days (6 to 111 days)) presenting at a tertiary children's hospital for suspicion of developmental dysplasia of the hip (DDH). Hips that did not require ultrasound follow-up or treatment were classified as 'typically developing'. We calculated traditional DDH indices like α angle (α_SP), femoral head coverage (FHC_SP), and several novel indices from 3DUS like the acetabular contact angle (ACA) and osculating circle radius (OCR) using custom software.

α angle, FHC, and ACA indices increased and OCR decreased significantly by age in the first four months, mean α_SP rose from 62.2° (SD 5.7°) to 67.3° (SD 5.2°) (p < 0.001) in one- to eight- and nine- to 16-week-old infants, respectively. Mean α_SP and mean FHC_SP were significantly, but only slightly, lower in females than in males. There was no statistically significant difference in DDH indices observed between left and right hip. All 3DUS indices varied significantly between anterior and posterior section of the hip. Mean 3D indices of α angle and FHC were significantly lower anteriorly than posteriorly: α_Ant = 58.2° (SD 6.1°), α_Post = 63.8° (SD 6.3°) (p < 0.001), FHC_Ant = 43.0 (SD 7.4), and FHC_Post = 55.4° (SD 11.2°) (p < 0.001). Acetabular rounding measured byOCR indices was significantly greater in the anterior section of the hip (p < 0.001).

We used 3DUS to show that hip shape and normal growth pattern vary significantly between anterior and posterior regions, by magnitudes similar to age-related changes. This highlights the need for careful selection of the Graf plane during 2D ultrasound examination. Whole-joint evaluation by obtaining either 3DUS or manual 'sweep' video images provides more comprehensive DDH assessment.Cite this article: Bone Jt Open 2022;3(11):913-923.