Sonographic hip screening and early management of developmental dysplasia of the hip

Abstract

The reliability of Graf's technique in diagnosing developmental dysplasia of the hip (DDH) is investigated in this report. In a prospective study, 6,548 neonates were examined clinically and sonographically; 470 children were reexamined at least once. Sonographic alpha angles and radiographic acetabular index (AI) angles were followed up and compared. Results were as follows: 84.6% of the hips were mature; 14.3% were physiologically immature; 1.1% were dysplastic. Of the sonographically dysplastic hips, 63% were clinically normal. Neonatal sonographic hip status was affected by family history, breech delivery, birth weight, and gestational age. At follow-up, none of the primarily mature hips had worsened. Of the type IIa hips, 89% matured spontaneously, and 11% needed abduction. The 68 dysplastic hips had matured after a maximum of 80 days' abduction, with normal alpha and AI angles by the end of treatment. At 1 year, the pitch had deteriorated again in six children. Graf's sonographic technique reliably diagnoses infantile DDH. Regular orthopedic checkups are needed to detect secondary deterioration of dysplastic hips.