Abstract
Developmental dysplasia of the hip (DDH) is an important but poorly defined entity, the natural history of which is incompletely understood. The term encompasses a disease spectrum ranging from a stable hip with a mildly dysplastic acetabulum to complete hip dislocation. Much controversy surrounds the diagnosis, imaging and management of this condition. We present a review of the history of US imaging of DDH from the radiologist’s perspective, summarising the most widely recognised US methods described to date. We discuss controversies in the approach to US examination, with particular emphasis on current opinions. The existing scientific evidence for and variations in the practice of US screening for DDH, including recommendations from the United States Preventive Services Task Force and the ESPR DDH Taskforce Group respectively, are discussed.
This is a preview of subscription content, access via your institution.




References
Dezateux C, Rosendahl K (2007) Developmental dysplasia of the hip. Lancet 369:1541–1552
Aronsson DD, Goldberg MJ, Kling TF Jr et al (1994) Developmental dysplasia of the hip. Pediatr 94:201–208
Sewell MD, Rosendahl K, Eastwood DM (2009) Developmental dysplasia of the hip. BMJ 339:b4454
Engesaeter IO, Lie SA, Lehmann TG et al (2008) Neonatal hip instability and risk of total hip replacement in young adulthood: follow-up of 2,218,596 newborns from the Medical Birth Registry of Norway in the Norwegian Arthroplasty Register. Acta Orthop 79:321–326
Bialik V, Bialik GM, Blazer S et al (1999) Developmental dysplasia of the hip: a new approach to incidence. Pediatrics 103:93–99
Leck I, Wald NJ (2000) Antenatal and neonatal screening, 2nd edn. Oxford University Press, Oxford
Bache CE, Clegg J, Herron M (2002) Risk factors for developmental dysplasia of the hip: ultrasonographic findings in the neonatal period. J Pediatr Orthop B 11:212–218
Roper A (1976) Hip dysplasia in the African Bantu. J Bone Joint Surg Br 58:155–158
Haasbeek JF, Wright JG, Hedden DM (1995) Is there a difference between the epidemiologic characteristics of hip dislocation diagnosed early and late? Can J Surg 38:437–438
Schwend RM, Pratt WB, Fultz J (1999) Untreated acetabular dysplasia of the hip in the Navajo. A 34 year case series followup. Clin Orthop Relat Res:108-116
Kremli MK, Alshahid AH, Khoshhal KI et al (2003) The pattern of developmental dysplasia of the hip. Saudi Med J 24:1118–1120
Kutlu A, Memik R, Mutlu M et al (1992) Congenital dislocation of the hip and its relation to swaddling used in Turkey. J Pediatr Orthop 12:598–602
Cady RB (2006) Developmental dysplasia of the hip: definition, recognition, and prevention of late sequelae. Pediatr Ann 35:92–101
Chan A, McCaul KA, Cundy PJ et al (1997) Perinatal risk factors for developmental dysplasia of the hip. Arch Dis Child Fetal Neonatal Ed 76:F94–100
Leck I (1986) An epidemiological assessment of neonatal screening for dislocation of the hip. J R Coll Physicians Lond 20:56–62
Yiv BC, Saidin R, Cundy PJ et al (1997) Developmental dysplasia of the hip in South Australia in 1991: prevalence and risk factors. J Paediatr Child Health 33:151–156
Tachdjian MO (1990) Pediatric orthopedics, 2nd edn. Saunders, Philadelphia
Wynne-Davies R (1970) Acetabular dysplasia and familial joint laxity: two etiological factors in congenital dislocation of the hip. A review of 589 patients and their families. J Bone Joint Surg Br 52:704–716
Wynne-Davies R (1970) A family study of neonatal and late-diagnosis congenital dislocation of the hip. J Med Genet 7:315–333
Czeizel A, Szentpetery J, Tusnady G et al (1975) Two family studies on congenital dislocation of the hip after early orthopaedic screening Hungary. J Med Genet 12:125–130
Stevenson DA, Mineau G, Kerber RA et al (2009) Familial predisposition to developmental dysplasia of the hip. J Pediatr Orthop 29:463–466
Shipman SA, Helfand M, Moyer VA et al (2006) Screening for developmental dysplasia of the hip: a systematic literature review for the US Preventive Services Task Force. Pediatrics 117:e557–576
von Heideken J, Green DW, Burke SW et al (2006) The relationship between developmental dysplasia of the hip and congenital muscular torticollis. J Pediatr Orthop 26:805–808
Tien YC, Su JY, Lin GT et al (2001) Ultrasonographic study of the coexistence of muscular torticollis and dysplasia of the hip. J Pediatr Orthop 21:343–347
Cheng JC, Tang SP, Chen TM (1999) Sternocleidomastoid pseudotumor and congenital muscular torticollis in infants: a prospective study of 510 cases. J Pediatr 134:712–716
Paton RW, Choudry Q (2009) Neonatal foot deformities and their relationship to developmental dysplasia of the hip: an 11-year prospective, longitudinal observational study. J Bone Joint Surg Br 91:655–658
Westberry DE, Davids JR, Pugh LI (2003) Clubfoot and developmental dysplasia of the hip: value of screening hip radiographs in children with clubfoot. J Pediatr Orthop 23:503–507
Wynne-Davies R (1965) Family studies and aetiology of club foot. J Med Genet 2:227–232
Barlow TG (1962) Early diagnosis and treatment of congenital dislocation of the hip. J Bone Joint Surg Br 44:292–301
Coffey MJ, Rahman MF, Thirkannad SM (2008) Pediatric ganglion cysts of the hand and wrist: an epidemiologic analysis. Hand (N Y) 3:359–362
Harcke HT, Grissom LE (1990) Performing dynamic sonography of the infant hip. AJR 155:837–844
Harcke HT, Grissom LE (1994) Infant hip sonography: current concepts. Semin Ultrasound CT MR 15:256–263
Graf R (1980) The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch Orthop Trauma Surg 97:117–133
Novick G, Ghelman B, Schneider M (1983) Sonography of the neonatal and infant hip. AJR 141:639–645
Harcke HT, Clarke NM, Lee MS et al (1984) Examination of the infant hip with real-time ultrasonography. J Ultrasound Med 3:131–137
Morin C, Harcke HT, MacEwen GD (1985) The infant hip: real-time US assessment of acetabular development. Radiology 157:673–677
Dahlstrom H, Oberg L, Friberg S (1986) Sonography in congenital dislocation of the hip. Acta Orthop Scand 57:402–406
Terjesen T, Bredland T, Berg V (1989) Ultrasound for hip assessment in the newborn. J Bone Joint Surg Br 71:767–773
Rosendahl K, Markestad T, Lie RT (1992) Ultrasound in the early diagnosis of congenital dislocation of the hip: the significance of hip stability versus acetabular morphology. Pediatr Radiol 22:430–433
Graf R (1984) Classification of hip joint dysplasia by means of sonography. Arch Orthop Trauma Surg 102:248–255
Graf R (1997) Advantages and disadvantages of various access routes in sonographic diagnosis of dysplasia and luxation in the infant hip. J Pediatr Orthop B 6:248–252
Graf R (1985) Possibilities, problems and present status of hip sonography of infant hips. Radiologe 25:127–134
Graf R (2006) Hip sonography: Diagnosis and management of infant hip dysplasia, 2nd edn. Springer, Berlin
Graf R (1992) Hip sonography—how reliable? Sector scanning versus linear scanning? Dynamic versus static examination? Clin Orthop Relat Res:18-21
Morin C, Zouaoui S, Delvalle-Fayada A et al (1999) Ultrasound assessment of the acetabulum in the infant hip. Acta Orthop Belg 65:261–265
Terjesen T, Runden TO, Tangerud A (1989) Ultrasonography and radiography of the hip in infants. Acta Orthop Scand 60:651–660
Rosendahl K, Markestad T, Lie RT (1996) Developmental dysplasia of the hip: prevalence based on ultrasound diagnosis. Pediatr Radiol 26:635–639
Palmen K (1961) Preluxation of the hip joint. Diagnosis and treatment in the newborn and the diagnosis of congenital dislocation of the hip joint in Sweden during the years 1948-1960. Acta Paediatr Suppl 50:1–71
Finnbogason T, Jorulf H (1997) Dynamic ultrasonography of the infant hip with suspected instability. A new technique. Acta Radiol 38:206–209
Suzuki S, Kasahara Y, Futami T et al (1991) Ultrasonography in congenital dislocation of the hip. Simultaneous imaging of both hips from in front. J Bone Joint Surg Br 73:879–883
Suzuki S, Kasahara Y, Yamamoto A et al (1993) Measurement of acetabular angle using ultrasound. Arch Orthop Trauma Surg 112:131–133
Reikeras O, Kristiansen LP, Gunderson R (2002) Ultrasonography of the infant hip: the significance of provokable instability with normal morphology. Orthop 25:833–835
Kosar P, Ergun E, Unlubay D et al (2009) Comparison of morphologic and dynamic US methods in examination of the newborn hip. Diagn Interv Radiol 15:284–289
Arthur R, Riccabona M, Toma P et al (2011) European Society of Paediatric Radiology’s Task force group on DDH Recommendations on hip screening. [cited 2012 29/03/2012]; Available from: http://www.espr.org/index.php?option = com_content&view = article&id = 207:recommendations-on-hip-screening&catid = 131:ddh-taskforce-recommendations&Itemid = 41
Omeroglu H, Bicimoglu A, Koparal S et al (2001) Assessment of variations in the measurement of hip ultrasonography by the Graf method in developmental dysplasia of the hip. J Pediatr Orthop B 10:89–95
Roovers EA, Boere-Boonekamp MM, Geertsma TS et al (2003) Ultrasonographic screening for developmental dysplasia of the hip in infants. Reproducibility of assessments made by radiographers. J Bone Joint Surg Br 85:726–730
Dias JJ, Thomas IH, Lamont AC et al (1993) The reliability of ultrasonographic assessment of neonatal hips. J Bone Joint Surg Br 75:479–482
Zieger M et al (1986) Ultrasound of the infant hip. Part 2. Validity of the method. Pediatr Radiol 16:488–492
Rosendahl K, Aslaksen A, Lie RT et al (1995) Reliability of ultrasound in the early diagnosis of developmental dysplasia of the hip. Pediatr Radiol 25:219–224
Bar-On E, Meyer S, Harari G et al (1998) Ultrasonography of the hip in developmental hip dysplasia. J Bone Joint Surg Br 80:321–324
Ramwadhdoebe S, Sakkers RJ, Uiterwaal CS et al (2010) Evaluation of a training program for general ultrasound screening for developmental dysplasia of the hip in preventive child health care. Pediatr Radiol 40:1634–1639
Falliner A, Schwinzer D, Hahne HJ et al (2006) Comparing ultrasound measurements of neonatal hips using the methods of Graf and Terjesen. J Bone Joint Surg Br 88:104–106
Peterlein CD, Schuttler KF, Lakemeier S et al (2010) Reproducibility of different screening classifications in ultrasonography of the newborn hip. BMC Pediatr 10:98
Czubak J, Kotwicki T, Ponitek T et al (1998) Ultrasound measurements of the newborn hip. Comparison of two methods in 657 newborns. Acta Orthop Scand 69:21–24
Irha E, Vrdoljak J, Vrdoljak O (2004) Evaluation of ultrasonographic angle and linear parameters in the diagnosis of developmental dysplasia of the hip. J Pediatr Orthop B 13:9–14
Gunay C, Atalar H, Dogruel H et al (2009) Correlation of femoral head coverage and Graf alpha angle in infants being screened for developmental dysplasia of the hip. Int Orthop 33:761–764
Andersson JE (2002) Neonatal hip instability: results and experiences from ten years of screening with the anterior-dynamic ultrasound method. Acta Paediatr 91:926–929
Finnbogason T, Jorulf H, Soderman E et al (2008) Neonatal hip instability: a prospective comparison of clinical examination and anterior dynamic ultrasound. Acta Radiol 49:212–219
Lehmann HP, Hinton R, Morello P et al (2000) Developmental dysplasia of the hip practice guideline: technical report. Committee on Quality Improvement, and Subcommittee on Developmental Dysplasia of the Hip. Pediatrics 105:E57
Finnbogason T, Jorulf H, Soderman E et al (2008) Anterior dynamic ultrasound and Graf's examination in neonatal hip instability. Acta Radiol 49:204–211
Wilson JMG, Jungner G (1968) Principles and practice of screening for disease. WHO Chronicle 22:473
Graf R, Tschauner C, Klapsch W (1993) Progress in prevention of late developmental dislocation of the hip by sonographic newborn hip “screening”: results of a comparative follow-up study. J Pediatr Orthop B 2:115–121
Riboni G, Bellini A, Serantoni S et al (2003) Ultrasound screening for developmental dysplasia of the hip. Pediatr Radiol 33:475–481
Toma P, Valle M, Rossi U et al (2001) Paediatric hip—ultrasound screening for developmental dysplasia of the hip: a review. Eur J Ultrasound 14:45–55
Brown J, Dezateux C, Karnon J et al (2003) Efficiency of alternative policy options for screening for developmental dysplasia of the hip in the United Kingdom. Arch Dis Child 88:760–766
Rosendahl K, Toma P (2007) Ultrasound in the diagnosis of developmental dysplasia of the hip in newborns. The European approach. A review of methods, accuracy and clinical validity. Eur Radiol 17:1960–1967
Rosendahl K, Markestad T, Lie RT (1994) Ultrasound screening for developmental dysplasia of the hip in the neonate: the effect on treatment rate and prevalence of late cases. Pediatrics 94:47–52
Holen KJ, Tegnander A, Bredland T et al (2002) Universal or selective screening of the neonatal hip using ultrasound? A prospective, randomised trial of 15,529 newborn infants. J Bone Joint Surg Br 84:886–890
Elbourne D, Dezateux C, Arthur R et al (2002) Ultrasonography in the diagnosis and management of developmental hip dysplasia (UK Hip Trial): clinical and economic results of a multicentre randomised controlled trial. Lancet 360:2009–2017
von Kries R, Ihme N, Oberle D et al (2003) Effect of ultrasound screening on the rate of first operative procedures for developmental hip dysplasia in Germany. Lancet 362:1883–1887
Mahan ST, Katz JN, Kim YJ (2009) To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Joint Surg Am 91:1705–1719
Dezateux C, Brown J, Arthur R et al (2003) Performance, treatment pathways, and effects of alternative policy options for screening for developmental dysplasia of the hip in the United Kingdom. Arch Dis Child 88:753–759
Patel H (2001) Preventive health care, 2001 update: screening and management of developmental dysplasia of the hip in newborns. CMAJ 164:1669–1677
Woolacott NF, Puhan MA, Steurer J et al (2005) Ultrasonography in screening for developmental dysplasia of the hip in newborns: systematic review. BMJ 330:1413
Dezateux C, Godward S (1996) A national survey of screening for congenital dislocation of the hip. Arch Dis Child 74:445–448
Cashman JP, Round J, Taylor G et al (2002) The natural history of developmental dysplasia of the hip after early supervised treatment in the Pavlik harness. A prospective, longitudinal follow-up. J Bone Joint Surg Br 84:418–425
Kalamchi A, MacFarlane R 3rd (1982) The Pavlik harness: results in patients over three months of age. J Pediatr Orthop 2:3–8
Weinstein SL, Mubarak SJ, Wenger DR (2004) Developmental hip dysplasia and dislocation: Part II. Instr Course Lect 53:531–542
Wood MK, Conboy V, Benson MK (2000) Does early treatment by abduction splintage improve the development of dysplastic but stable neonatal hips? J Pediatr Orthop 20:302–305
Rosendahl K, Dezateux C, Fosse KR et al (2010) Immediate treatment versus sonographic surveillance for mild hip dysplasia in newborns. Pediatr 125:e9–16
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bracken, J., Ditchfield, M. Ultrasonography in developmental dysplasia of the hip: what have we learned?. Pediatr Radiol 42, 1418–1431 (2012). https://doi.org/10.1007/s00247-012-2429-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-012-2429-8