Abstract
Purpose
The purpose of this study was to simplify and enhance the ultrasound (US) analysis of the infant’s hip by introducing a novel parameter named “L value” into the widely used Graf method.
Methods
We analysed 508 ultrasonographic images of the hips in infants aged three months. The images were first evaluated using the Graf measurements. On the same images, two additional measurements were performed in order to define the new parameter that was named L value. The threshold values of the new L value were identified based on the highest specificity as well as sensitivity for discrimination between the Graf groups. Those values were then used in order to reclassify the hips into three simplified groups. Inter-observer agreement was estimated by Cohen’s kappa coefficient.
Results
The threshold values for the L value between Graf groups Ia and Ib was 0.46, between Ib and IIb was 0.68 and between IIb and IIc was 0.92. Correlation analysis between Graf’s classification and the values of the L value was performed and was proved to be statistically significant, r = 0.49; p < 0.001. After simplifying the classification into three newly defined groups of patients depending on the degree of hip development, the correlation coefficient was much higher, r = 0.94, r 2 = 0.88 for p < 0.001. Inter-observer agreement for the L value was substantial.
Conclusions
The new L value parameter in Graf’s ultrasound hip evaluation enables a faster, simpler, more reliable and more unbiased classification for developmental dysplasia of the hip as the L value changes proportionally with the hip maturity.
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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
Kocher MS (2000) Ultrasonographic screening for developmental dysplasia of the hip: an epidemiologic analysis (part I). Am J Orthop 29:929–933
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
Patel H, Canadian Task Force on Preventive Health Care (2001) Canadian task force on preventive health care. Preventive health care, 2001 update: screening and management of developmental dysplasia of the hip in newborns. CMAJ 164:1669–1677
Shipman SA, Helfand M, Moyer VA, Yawn BP (2006) Screening for developmental dysplasia of the hip: a systematic literature review for the US Preventive Services Task Force. Pediatrics 117:e557–e576
American Academy of Pediatrics (2000) Clinical practice guideline: early detection of developmental dysplasia of the hip. Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the Hip. Pediatrics 105:896–905
Bialik V, Bialik GM, Blazer S, Sujov P, Wiener F, Berant M (1999) Developmental dysplasia of the hip: a new approach to incidence. Pediatrics 103:93–99
Graf R (1984) Fundamentals of sonographic diagnosis of infant hip dysplasia. J Pediatr Orthop 4:735–740
Graf R (2006) Hip sonography, 2nd edn. Springer, Berlin, p 41
Simon EA, Saur F, Buerge M, Glaab R, Roos M, Kohler G (2004) Inter-observer agreement of ultrasonographic measurement of alpha and beta angles and the final type classification based on the Graf method. Swiss Med Wkly 134:671–677
Dias JJ, Thomas IH, Lamont AC, Mody BS, Thompson JR (1993) The reliability of ultrasonographic assessment of neonatal hips. J Bone Joint Surg Br 75:479–482
Tudor A, Sestan B, Rakovac I et al (2007) The rational strategies for detecting developmental dysplasia of the hip at the age of 4–6 months old infants: a prospective study. Coll Antropol 31:475–481
Morin C, Harcke HT, MacEwen GD (1985) The infant hip: real-time US assessment of acetabular development. Radiology 157:673–677
Gunay C, Atalar H, Dogruel H, Yavuz OY, Uras I, Sayli U (2009) Correlation of femoral head coverage and Graf α angle in infants being screened for developmental dysplasia of the hip. Int Orthop 33:761–764
Harcke HT, Clarke NM, Lee MS, Borns PF, MacEwen GD (1984) Examination of the infant hip with real-time ultrasonography. J Ultrasound Med 3:131–137
Terjesen T, Rundén TO, Tangerud A (1989) Ultrasonography and radiography of the hip in infants. Acta Orthop Scand 60:651–660
Terjesen T, Bredland T, Berg V (1989) Ultrasound for hip assessment in the newborn. J Bone Joint Surg Br 71:767–773
Suzuki S, Kasahara Y, Futami T, Ushikubo S, Tsuchiya T (1991) Ultrasonography in congenital dislocation of the hip. Simultaneous imaging of both hips from in front. J Bone Joint Surg Br 73:879–883
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Rakovac, I., Tudor, A., Sestan, B. et al. New “L value” parameter simplifies and enhances hip ultrasound interpretation in the detection of developmental dysplasia of the hip. International Orthopaedics (SICOT) 35, 1523–1528 (2011). https://doi.org/10.1007/s00264-011-1256-0
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DOI: https://doi.org/10.1007/s00264-011-1256-0