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. 2018 Nov 15;35(6):427-430.
doi: 10.4274/balkanmedj.2017.1150. Epub 2018 Jul 3.

Treatment of Graf Type IIa Hip Dysplasia: A Cut-off Value for Decision Making

Fuat Bilgili  1 , Yavuz Sağlam  2 , Süleyman Bora Göksan  1 , Önder Murat Hürmeydan  1 , Fevzi Birişik  1 , Mehmet Demirel  1
Affiliations

Treatment of Graf Type IIa Hip Dysplasia: A Cut-off Value for Decision Making

Fuat Bilgili et al. Balkan Med J. .

Abstract

Background: The rate of spontaneous normalization in type IIa hips is reported to be high, whereas dysplsia persists or worsens in 5%-10% of cases.

Aims: To evaluate the natural course of type IIa hips using Graf’s own perspective of physiological immaturity and maturational deficit.

Study design: A single center, retrospective cohort study.

Methods: This was an institutional review board-approved retrospective review of all patients diagnosed with type IIa hip dysplasia at a single institution from 2012 to 2014. All patients included in the study had hip ultrasonography at about 6 weeks and 3 months of age. To assess reliability in α and β angles, ultrasonography measurements were carried out on the same image individually by all observers. The α and β angles were used as the main outcome measurements to evaluate hip maturation at the last follow-up. A receiver operating characteristics curve was drawn at the 3 month ultrasonography to evaluate the cut-off values for α and β angles for persistent dysplasia.

Results: Sixty-four patients and 88 affected hips (63% unilateral and 37% bilateral) were included. The mean age at diagnosis was 6.4±2.7 weeks. Fifty-four hips were type IIa(+) (physiologically immature) and 34 hips were type IIa(-) (maturational deficit) at the initial ultrasonography evaluation. Improvement to type I was seen in 52 type IIa(+) and 17 type IIa(-) hips. Receiver operating characteristic analyses showed that patients do well if the α angle was >55° (area under the curve: 0.86; p<0.001 for the left hip and area under the curve: 0.72; p=0.008 for the right hip).

Conclusion: The cut-off α angle value of 55° on initial ultrasonography should be considered to prevent future dysplasia. An α angle <55° on the initial ultrasonography was an independent predictor of worsening sonographic findings.

Keywords: Decisioion making; Graf type IIa; Hip dysplasia; Ultrasonography.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1. Definition of type IIa(+) hips; The alpha angle should be ≥55° in week 6, ≥56° in week 7, >57° in week 9, >58° in week 11 and ≥60° in week 12. If the angle is >50° but it was not classified as type IIa(+) at these weeks of age, it should be classified as type IIa(-).
Figure 2
Figure 2. Initial and follow-up ultrasound measurements and typology of the hips.
Figure 3
Figure 3. Receiver operating characteristic curve of the α values for the right hip. ROC: Receiver operating characteristic
Figure 4
Figure 4. Receiver operating characteristic curve of the α values for the left hip. ROC: Receiver operating characteristic
Figure 5
Figure 5. Receiver operating characteristic curve of the β values for the left and right hips. ROC: Receiver operating characteristic
See this image and copyright information in PMC

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