Assessment of Variations in the Measurement of Hip Ultrasonography by the Graf Method in Developmental Dysplasia of the Hip§

Ömeroğlu, Hakan; Biçmoǧlu, Ali; Koparal, Süha; Seber, Sinan

doi:10.1097/01202412-200110020-00002

Cited by 46 publications

(36 citation statements)

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“…Our findings cannot be related directly to those of others, because it is not always clear how the different types of hip were distributed and because the hips were classified into a different number of groups. Bar-On et al 10 and Ömeroglu et al 9 found interobserver kappa values of 0.57 and 0.46, which were slightly lower than our kappa values. Ömeroglu et al 9 classified the hips into three groups, which could explain their lower kappa values.…”

Section: Discussioncontrasting

confidence: 80%

“…Bar-On et al 10 and Ömeroglu et al 9 found interobserver kappa values of 0.57 and 0.46, which were slightly lower than our kappa values. Ömeroglu et al 9 classified the hips into three groups, which could explain their lower kappa values. The intraobserver kappa values reported by Bar-On et al 10 and Ömeroglu et al 9 were comparable with those of three of our radiographers.…”

Section: Discussioncontrasting

confidence: 80%

“…These results support the conclusion of others that variance in alpha and beta angles is large, even when the angles are measured by the same observer. [7][8][9][10][11] The radiologist read more of the ultrasonograms as immature or abnormal than the radiographers, although he had attended the same ultrasonography course and the radiographers were working under his supervision during the screening project. An explanation could be that he had higher a priori expectations of DDH based on his clinical experience.…”

Section: Discussionmentioning

confidence: 99%

“…Zieger 7 and Rosendahl et al 8 reported acceptable interobserver agreement when hips were defined by visual analysis. Ömeroglu et al 9 and Bar-On et al 10 concluded that the exact Graf classification had a moderate level of reliability, but that agreement about the method of treatment, according to Graf's recommendations, seemed to be satisfactory. On the other hand, Dias et al 11 showed poor agreement between the measurements on which Graf based his classification.…”

Section: Received 1 October 2002; Accepted After Revision 11 March 2003mentioning

confidence: 99%

See 3 more Smart Citations

Ultrasonographic screening for developmental dysplasia of the hip in infants

Roovers

Boere-Boonekamp

Geertsma

et al. 2003

The Journal of Bone and Joint Surgery. British volume

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We studied the reproducibility of ultrasonographic screening examination of the hip when read by diagnostic radiographers. In order to determine interobserver variability, 200 ultrasonograms were classified according to Graf’s method by five observers (four radiographers and one radiologist). The kappa values for interobserver variability indicated moderate agreement (kappa 0.47) for the exact Graf classification and substantial agreement (kappa 0.65) for the classification of normal (type I) versus abnormal (type IIa-IV). Agreement was significantly different for normal, immature and abnormal hips. Comparison of the findings in our interobserver study with existing information based on other examinations and treatment revealed that only a small number of infants with mildly dysplastic hips would have been typed as normal by some observers as a result of observer variability. In conclusion, the interobserver agreement on the ultrasound assessment of the hip was good enough for screening purposes. Observer variability did not result in any severe cases being missed.

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Section: Discussioncontrasting

confidence: 80%

Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Received 1 October 2002; Accepted After Revision 11 March 2003mentioning

confidence: 99%

See 2 more Smart Citations

Ultrasonographic screening for developmental dysplasia of the hip in infants

Roovers

Boere-Boonekamp

Geertsma

et al. 2003

The Journal of Bone and Joint Surgery. British volume

View full text Add to dashboard Cite

show abstract

“…The reported intraobserver and interobserver reliability concerning the hip typing in the Graf method ranged from moderate to substantial and from fair to substantial, respectively [21–26]. Besides, the reported intraobserver and interobserver measurement variability of the α angle ranged from 4° to 11° and from 3° to 13°, respectively [21, 23, 24, 26, 27]. The reported intraobserver and interobserver measurement variability of the β angle was between 6° and 14° and between 6° and 19°, respectively [23, 24, 26, 27].…”

Section: Consistency Of the Infantile Hip Ultrasonography Methodsmentioning

confidence: 99%

Use of ultrasonography in developmental dysplasia of the hip

Ömeroğlu

2014

Journal of Children's Orthopaedics

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PurposeUltrasonography has been used as a diagnostic tool in developmental dysplasia of the hip (DDH) during early infancy since the early 1980s. The aim of this review article is to summarise the technique, benefits and shortcomings of four infantile hip ultrasonography methods, focusing mainly on the Graf method, and to assess the effectiveness of ultrasonographic newborn hip screening programmes.MethodsSeveral infantile hip ultrasonography methods have been defined to assess the relationship between the femoral head and acetabulum. The Graf, Harcke, Terjesen and Suzuki methods are the universally known ones. The Graf method is composed of a quantitative classification system, while the Harcke and Suzuki methods have qualitative definitions and the Terjesen method contains both quantitative and qualitative descriptions.ResultsAlthough the results of several studies assessing the sensitivity and consistency of the ultrasonography methods have still not proven a clear dominance of one of these techniques, the primary advantage of the Graf method is that it has a standardised examination technique, as well as a very well defined numeric hip typing system. The importance of newborn hip screening has been universally accepted, but there is still no strong evidence regarding the superiority of either universal (screening of all newborns) or selective (screening of high-risk newborns) ultrasonographic newborn hip screening programmes.ConclusionsAn effective ultrasonographic method should include simple, precise, quantitative and consistent definitions for a proper examination and diagnosis. Both universal and selective ultrasonographic newborn hip screening programmes have significantly decreased the rate of late detected DDH and lessened the need for surgical treatment.

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Measurement of Pubofemoral Distance in the Diagnosis of Developmental Dysplasia of the Hip: Sensitivity and Specificity

Motta

Chiovatto²,

Chiovatto³

et al. 2021

J of Ultrasound Medicine

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Objectives To evaluate the accuracy of measurement of the pubofemoral distance (PFD) for the diagnosis of developmental dysplasia of the hip (DDH), using the Graf method as the reference standard. Methods This was a prospective diagnostic accuracy study evaluating 1980 hips in at‐risk neonates. The PFD measurement and the Graf method were performed at the same opportunity, with the hips in the same position (slightly flexed, adducted, and medially rotated). Results In our sample, the prevalence of DDH, defined as Graf type IIb or higher, was 15.6%. The mean PFD for dysplastic hips was 3.5 mm (median, 3.3 mm), whereas it was 3.0 mm (median, 2.9 mm) for nondysplastic hips. In both groups, there was a significant overlap between the PFD measurements and the Graf classifications. The PFD cutoff with the largest area under the receiver operating characteristic curve was 3.0 mm, which was found to have a sensitivity and specificity of 63.6 and 62.2%, respectively, with positive and negative predictive values of 31.2 and 71.4%, respectively, for the diagnosis of DDH. Conclusion Measurement of the PFD shows good overall accuracy for the diagnosis of DDH. However, given its low‐positive predictive value, it should not be considered to be a replacement for the Graf method.

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Assessment of Variations in the Measurement of Hip Ultrasonography by the Graf Method in Developmental Dysplasia of the Hip§

Cited by 46 publications

References 0 publications

Ultrasonographic screening for developmental dysplasia of the hip in infants

Ultrasonographic screening for developmental dysplasia of the hip in infants

Use of ultrasonography in developmental dysplasia of the hip

Measurement of Pubofemoral Distance in the Diagnosis of Developmental Dysplasia of the Hip: Sensitivity and Specificity

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