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Ultrasound of the neonatal hip as a screening tool for DDH: how to screen and differences in screening programs between European countries

Iris Kilsdonk
Iris Kilsdonk
, 
Melinda Witbreuk
Melinda Witbreuk
 y 
Henk-Jan Van Der Woude
Henk-Jan Van Der Woude
   | 18 jun 2021
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Article Category: review-article
Publicado en línea: 18 jun 2021
Páginas: 147 - 153
Recibido: 20 feb 2021
Aceptado: 13 may 2021
DOI: https://doi.org/10.15557/jou.2021.0024
Palabras clave
© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

Ultrasound of a normal Graf 1 hip: A. Landmarks on standard imaging plane 1 – bony acetabular rim, 2 – triradiate cartilage, 3 – labrum; B. Measurement of alpha–angle as the angle between baseline and acetabular line (landmarks 1 and 2) and measurement of beta–angle as the angle between baseline and inclination line (landmarks 1 and 3)
Ultrasound of a normal Graf 1 hip: A. Landmarks on standard imaging plane 1 – bony acetabular rim, 2 – triradiate cartilage, 3 – labrum; B. Measurement of alpha–angle as the angle between baseline and acetabular line (landmarks 1 and 2) and measurement of beta–angle as the angle between baseline and inclination line (landmarks 1 and 3)

Fig. 2.

Staging of DDH according to Graf: A. Graf 2A; B. Graf 2B; C. Graf 2C; D. Graf D; E. Graf 3; F. Graf 4. * 1 – bony acetabular rim, 2 – triradiate cartilage, 3 – labrum. ** In F. Graf 4 not the optimal probe position for depicting the triradiate cartilage was chosen, so landmark 2 is not depicted
Staging of DDH according to Graf: A. Graf 2A; B. Graf 2B; C. Graf 2C; D. Graf D; E. Graf 3; F. Graf 4. * 1 – bony acetabular rim, 2 – triradiate cartilage, 3 – labrum. ** In F. Graf 4 not the optimal probe position for depicting the triradiate cartilage was chosen, so landmark 2 is not depicted

Fig. 3.

Measuring DDH beyond angles, using A. Femoral head coverage (in %, where >58% is the reference value for a normal hip) and B. Pubofemoral distance (in mm, where <6 mm is the reference for a normal hip)
Measuring DDH beyond angles, using A. Femoral head coverage (in %, where >58% is the reference value for a normal hip) and B. Pubofemoral distance (in mm, where <6 mm is the reference for a normal hip)

Fig. 4.

Lateral dynamic ultrasound procedure showing a Graf 3 hip during Barlow/posterior pressure maneuver with the femoral head moving away from the medial side of the acetabulum
Lateral dynamic ultrasound procedure showing a Graf 3 hip during Barlow/posterior pressure maneuver with the femoral head moving away from the medial side of the acetabulum

Fig. 5.

Normal anterior transinguinal ultrasound of the hip in a spica cast, showing the pubic bone in line with the femoral neck
Normal anterior transinguinal ultrasound of the hip in a spica cast, showing the pubic bone in line with the femoral neck

Graf classification scale for developmental dysplasia of the hip

Type Alpha angle Acetabular modelling Bony acetabular rim Beta angle Labrum Position of femoral head Age
1A >60° good sharp <55° good femoral coverage central all
1B >60° good slightly rounded <55° good femoral coverage central all
2A 50–59° deficient rounded <55° coverage femoral head central <3 mo
2B 50–59° deficient rounded <55° coverage femoral head central >3 mo
2C 43–49° severely deficient rounded/flat >55 but <77° still coverage femoral head stable or unstable all
D 43–49° severely deficient rounded/flat >77° still coverage femoral head decentering all
3 <43° poor flat labrum pressed upwards eccentric all
4 <43° poor flat labrum pressed downwards/disappears eccentric all

Different screening programs across Europe for the detection of DDH in newborns

Country Type of ultrasound screening Timing (week)
The Netherlands selective 12
Belgium selective <12
France selective <4
Portugal selective 6–8
Italy universal 4–12
Austria universal 1 6–8
Switzerland universal <5
Germany universal Risk factor + 1–2 Risk factor – 4–5
Sweden selective 1–12
Norway selective 1
Hungary selective <6
Slovenia universal Risk factor + 1–2 Risk factor – 6
Slovakia universal 1–12
United Kingdom selective 6
Ireland selective 6

Example of standard report in ultrasound of DDH

Acetabular modelling: good/adequate/deficient/poor
Bony acetabular rim: sharp/rounded/flat
Alpha angle (°)
Femoral head: ossification no/symmetric/asymmetric
Femoral head position: centric – eccentric
Beta angle (°)
eISSN:
2451-070X
Idioma:
Inglés
Calendario de la edición:
4 veces al año
Temas de la revista:
Medicine, Basic Medical Science, other
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