Ultrasound Is an Alternative to X-ray for Diagnosing Developmental Dysplasia of the Hips in 6-Month-Old Children



Infants previously treated for developmental dysplasia of the hips (DDH) are routinely imaged with ultrasound initially and reimaged with an anteroposterior (AP) pelvis X-ray at 6 months of age to assess for dysplasia. It has become convention to transition from ultrasound to AP X-ray at 6 months of age, but no study has demonstrated that ultrasound is inadequate at this age.


The purpose of this study was to confirm that ultrasound for the 6-month DDH evaluation is a feasible alternative to the standard X-ray.

Patients and Methods

Thirty-one 5- to 7-month-old infants undergoing AP pelvis X-ray related to previous Pavlik harness treatment for DDH or to a history of breech presentation were prospectively enrolled. All patients were imaged with an AP pelvis X-ray and bilateral hip ultrasounds. Three senior orthopedic surgeons unfamiliar with the patient histories evaluated both types of imaging for standard measures of hip dysplasia, including acetabular index (AI), alpha angle, and bony rim percent coverage of the femoral head. Pearson correlation coefficients were calculated for the X-ray and ultrasound measures.


Good quality ultrasound images were obtained in all patients, despite the presence of the ossific nucleus in 66% of the hips. All three reviewers correctly diagnosed the one dislocated hip via both X-ray and ultrasound. There were no false negatives on ultrasound, and none of the patients with negative ultrasounds required treatment during the mean 26 months of follow up. An increased AI on X-ray was correlated with lower percent coverage of the femoral head on ultrasound.


Ultrasound is a technically feasible DDH imaging modality that can be used as an alternative to X-ray for 6-month-olds.

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The authors wish to thank Dr. John Blanco and Dr. David Scher for contributing their patients to this study.


Huong Do, MA, declares that research reported in this publication was financially supported by the National Center for Advancing Translational Sciences of the National Institute of Health (no. UL1-RR024996).

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Correspondence to Shevaun M. Doyle MD.

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Conflict of Interest

Alison Kitay, MD, Roger F. Widmann, MD, Shevaun M. Doyle, MD, Huong T. Do, MA, and Daniel W. Green, MD, declare that they have no conflicts of interest.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

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Level of Evidence: Level II: Diagnostic Study

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Kitay, A., Widmann, R.F., Doyle, S.M. et al. Ultrasound Is an Alternative to X-ray for Diagnosing Developmental Dysplasia of the Hips in 6-Month-Old Children. HSS Jrnl 15, 153–158 (2019). https://doi.org/10.1007/s11420-018-09657-9

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  • developmental dysplasia of the hip
  • DDH
  • ultrasound
  • pediatrics