Diagnosing developmental dysplasia of the hip using the Graf ultrasound method: risk and protective factor analysis in 11,820 universally screened newborns

Schams, Mohammad; Labruyère, Rob; Zuse, Anne; Walensi, Mikolaj

doi:10.1007/s00431-017-2959-z

Cited by 33 publications

(37 citation statements)

References 55 publications

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“…The accompanying pathoanatomic obstacles greatly reduces the chance of a successful CR. Hence, early ultrasound screening using the Graf method in some countries is recommended to timely detect hip immaturity and pathologies and to provide the optimal approach [ 16 ]. Several studies reported older age at the time of CR showing a higher rate of complications or further corrective surgeries [ 5 – 7 ], while others not [ 8 , 9 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Timing for closed reduction procedure for developmental dysplasia of the hip and its failure analysis

Zhang

et al. 2020

BMC Musculoskelet Disord

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Background It remains controversial whether the older age to perform closed reduction (CR) procedure for developmental dysplasia of the hip (DDH), the higher incidence of complications. The aim of this study is to evaluate the midterm outcome of CR for DDH among different age groups, and to analyze and identify risk factors for the failure of this procedure. Methods Clinical data of 107 DDH patients, who received CR, were retrospectively reviewed. Data were divided into three groups according to initial treatment age (Group I: younger than 12 months; Group II: 12 months to less or equal to18 months; Group III: older than 18 months). The presence of avascular necrosis (AVN), residual acetabular dysplasia (RAD), re-dislocation, and further surgeries (FS) were observed. The risk factors were identified for those outcomes aforementioned using univariable logistic regression models. For identified risk factor age, pre-op acetabular index (AI) and post-op AI, their prediction of CR failure were evaluated by receiver operating characteristics curve (ROC). Results A total of 107 patients (156 hips) undergoing CR procedure were evaluated with a median age at initial reduction of 13.0 ± 5.4 months (range, 4 to 28 mo). Mean follow-up time in this study was 6.7 ± 0.8 years (range, 3–8 years). The incidence of AVN, RAD and re-dislocation was 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156) respectively. For AVN, RAD and re-dislocation, the significant risk factors are pre-op IHDI IV (p = 0.033), age ≥ 18 months (p = 0.012), and pre-op IHDI IV (p = 0.004) and walking (p = 0.011), respectively. The areas under the ROC curve of each type of failures were 0.841 (post-op AI), 0.688 (pre-op AI) and 0.650 (age). Conclusions Severe DDH patients older than 18 months with CR procedure may result in a high risk of RAD complication. Re-dislocation is significantly associated with pre-op IHDI IV and walking. Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are also more likely to fail of CR procedure.

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Section: Discussionmentioning

confidence: 99%

Timing for closed reduction procedure for developmental dysplasia of the hip and its failure analysis

Zhang

et al. 2020

BMC Musculoskelet Disord

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“…8 9 17 In the present study, breech presentation was reported in 36% of infants with DDH, and it significantly increased the likelihood of the condition (15-fold higher risk). The literature indicates that family history increases the incidence of DDH from 12 to 68 cases per 1,000 births; 3 6 18 19 20 24% of our sample had a previous history of the condition. Black ethnicity is mentioned as a protective factor, since DDH incidence in this population is three times lower compared to that of Caucasians; 10 however, this association was not confirmed in the sample evaluated in the present study.…”

Section: Discussionmentioning

confidence: 75%

“…Currently, the screening for DDH in newborns employs the maneuver described by Ortolani 24 for the assessment of hip dislocation and instability; in some cases, the screening is performed through an ultrasound (US) examination using the method described by Graf, who classifies type I hips as mature and stable, type IIa hips as immature, type IIb hips as immature and unstable, type IIc hips as unstable, and types III and IV hips as dislocated. 2 3 When the physical or US examination is positive, the Pavlik brace, a flexible orthosis to keep the hips in from 90 ∘ to 110 ∘ of flexion and safety zone abduction, between 30 ∘ and 60 ∘ , is used. 4 The success rate of this treatment ranges from 86 to 99%.…”

Section: Introductionmentioning

confidence: 99%

Perﬁl dos pacientes diagnosticados com displasia do desenvolvimento do quadril

Barbosa

Albernaz

2019

Rev Bras Ortop

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Objective To describe the proﬁle of patients with developmental dysplasia of the hip (DDH) diagnosed by physical and ultrasound examination, with the implementation of a protocol for the treatment and follow-up of DDH. Methods A cross-sectional study with DDH patients born between January 2014 and December 2016, in the city of Pelotas, Southern Brazil. Ethnicity, gender, birth weight, fetal presentation, affected side of the hip, gestational age, maternal age and family history were considered. The data on the medical records were compared with the characteristics of the general population described on the Brazilian National Information System on Live Births (Sistema de Informação sobre Nascidos Vivos [SINASC]). Results A total of 33 DDH patients were identiﬁed, mostly female, with a four-fold higher probability of having the condition ( p < 0.001); the left was the most affected side. No statistically signiﬁcant association was found regarding the following factors: birth weight, gestational age, ethnicity, and maternal age. The newborns in breech presentation had a 15-fold higher probability of presenting DDH ( p < 0.001). A total of 21 newborns required immediate treatment of the hips, since the ultrasound showed a Graf classiﬁcation of IIb or higher, or the radiography showed dislocation in DDH patients older than 6 months of age. Conclusion Screening for DDH is essential in all newborns; physical examinations revealing alterations must be complemented with ultrasound imaging to avoid the delayed diagnosis of the condition.

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“…Results of screening: General screening as a prevention of late DDH cases depends from the health system in the different countries. In Austria, Germany, Switzerland it is done up to 30 years [4,8] In other countries screening is done locally, the general results are the same: operation rate dropped down, head necrosis rate dropped done, conservative treatment rate dropped down, because the base for treatment had been an objective , reproducible sonogram and not a subjective feeling after a clinical examination (Fig. 6).…”

Section: Resultsmentioning

confidence: 99%

Hip sonography worldwide – experience, results, problems

Graf¹,

Synder²

2020

Chir. Narzadow Ruchu Ortop. Pol.

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Introduction. There is a confusion in the literature about the value of baby hip sonography to detect DDH. One of the reasons is, that different examination techniques with different results are used and the final results are mixed up. Materials and methods. The principles of the "Graf technique" with well-known common mistakes are described with the typing as a mirror of the pathoanatomical situation in the joint and compared with the other techniques. Results. According the German Quality Commission in 48% a wrong anatomical identification of the echoes leads to a wrong diagnosis. Checklist I (anatomical identification) and Checklist II (usability check) are necessary absolutely. The reason, why modified or other techniques leads to overdiagnosis or wrong diagnosis are pointed out: No standard plane, tilting effects, age not taken into account, no differentiation between instability and elastic wiping etc). More than 25 years general screening in some countries demonstrate the success: Operations as well as conservative treatment rate and costs dropped down dramatically. Conclusions. Hip sonography is not hip sonography. A special licenses after a training course in the technique by authorized teachers is necessary to keep the standard high. Sonograms must be comparable and independent from the experience and skill of the examiner. Modified or other techniques are not the standard of today and in some countries forbidden. Screening depends from the health systems in different countries also. But prevention is better than operation.

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Diagnosing developmental dysplasia of the hip using the Graf ultrasound method: risk and protective factor analysis in 11,820 universally screened newborns

Cited by 33 publications

References 55 publications

Timing for closed reduction procedure for developmental dysplasia of the hip and its failure analysis

Timing for closed reduction procedure for developmental dysplasia of the hip and its failure analysis

Perﬁl dos pacientes diagnosticados com displasia do desenvolvimento do quadril

Hip sonography worldwide – experience, results, problems

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