Morphological Development of the Hip in Normal Infants Under Six Months of Age by the Graf Ultrasound Method

Liu, Bing; Hu, Xiaoyun; Li, Lianyong; Gao, Shuxi

doi:10.3389/fped.2022.914545

Cited by 5 publications

(5 citation statements)

References 23 publications

(28 reference statements)

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“… 42 Studies have shown that most immature hips diagnosed via ultrasonography mature without any interventions during the first weeks of life. 92 However, it must be noted that in 1 of the largest studies reporting late detection rates before and after selective screening implementation in England, 87 the rate remained unchanged compared with prior clinical screening policy. The presented late detection rate (1.3 per 1000 neonates) was also extremely high, as studies with clinical screening only have had much lower rates (eg, a study in Sweden 84 that found a rate of 0.12 per 1000 neonates).…”

Section: Discussionmentioning

confidence: 98%

“…Another advantage is that if the selective screening is performed in delayed schedule for patients with hips with clinical suspicion, many of these hips have had time to mature and stabilize . Studies have shown that most immature hips diagnosed via ultrasonography mature without any interventions during the first weeks of life . However, it must be noted that in 1 of the largest studies reporting late detection rates before and after selective screening implementation in England, the rate remained unchanged compared with prior clinical screening policy.…”

Section: Discussionmentioning

confidence: 99%

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Incidence of Neonatal Developmental Dysplasia of the Hip and Late Detection Rates Based on Screening Strategy

et al. 2022

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ImportanceUniversal ultrasonographic screening for developmental dysplasia of the hip (DDH) has gained increasing popularity despite the lack of benefit in terms of reducing the rates of late-detected cases (age ≥12 weeks) in randomized clinical trials.ObjectiveTo report the reported incidence of DDH in the English scientific literature and compare rates of late-detected cases in settings with different DDH screening strategies.Data SourcesPubMed, Scopus, and Web of Science databases were searched on November 25 and 27, 2021. No time filters were used in the search.Study SelectionAll observational studies reporting the incidence of early-detected or late-detected (age ≥12 weeks) DDH were included. Non-English reports were excluded if the abstract did not include enough information to be included for analysis.Data Extraction and SynthesisThe number of newborns screened and the detection rates were extracted. Meta-analysis calculated the pooled incidence of DDH per 1000 newborns with 95% CIs using a random- or fixed-effects model. This study is reported according to the PRISMA and MOOSE guidelines.Main Outcomes and MeasuresThe main outcome measures were early detection, early treatment, late detection, and operative treatment incidences.ResultsA total of 1899 studies were identified, 203 full texts were assessed, and 76 studies with 16 901 079 infants were included in final analyses. The early detection rate was 8.4 (95% CI, 4.8-14.8) infants with DDH per 1000 newborns with clinical screening, 4.4 (95% CI, 2.4-8.0) infants with DDH per 1000 newborns with selective ultrasonographic screening, and 23.0 (95% CI, 15.7-33.4) infants with DDH per 1000 newborns with universal ultrasonographic screening. Rates for nonoperative treatment were 5.5 (95% CI, 2.1-14) treatments per 1000 newborns with clinical screening, 3.1 (95% CI, 2.0-4.8) treatments per 1000 newborns with selective ultrasonographic screening, and 9.8 (95% CI, 6.7-14.4) treatments per 1000 newborns with universal ultrasonographic screening. The incidence of late-detected DDH was 0.5 (95% CI, 0.2-1.5) infants with DDH per 1000 newborns with clinical screening, 0.6 (95% CI, 0.3-1.3) infants with DDH per 1000 newborns with selective ultrasonographic screening, and 0.2 (95% CI, 0.0-0.8) infants with DDH per 1000 newborns with universal ultrasonographic screening. The corresponding incidences of operative treatment were 0.2 (95% CI, 0.0-0.9) operations per 1000 newborns with clinical screening, 0.5 (95% CI, 0.4-0.7) operations per 1000 newborns with selective ultrasonographic screening, and 0.4 (95% CI, 0.2-0.7) operations per 1000 newborns with universal ultrasonographic screening.Conclusions and RelevanceThis meta-analysis found that early detection rates and nonoperative treatments were higher with universal screening. The late detection and operative treatment rates with universal screening were similar to those among selectively and clinically screened newborns. Based on these results, universal screening may cause initial overtreatment without reducing the rates of late detection and operative treatment.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Incidence of Neonatal Developmental Dysplasia of the Hip and Late Detection Rates Based on Screening Strategy

et al. 2022

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“…Between the infants with DDH Graf type II, hips with maturational deficit Graf type IIa (-) were the most frequent finding (74% of DDH Graph type II) in our study. Many authors reported that 85% of DDH Grapf IIa (-) reached normality without any treatment at the end of the 3rd month of age (10). A greater number, even 35% of the hips with maturation deficit in our investigation turned into true dysplastic hips throughout the treatment monitoring period.…”

Section: Discussionmentioning

confidence: 42%

“…Bilgili et al determined the cut-off value of 55° on initial sonography as an independent predictor of worsening sonographic findings (9). It has been reported that 85% of Graf type IIa (-) hips have developed into normal hips without any treatment by the age of 3 months and then enter a plateau period during the 4 to 6th month (10).…”

Section: Introductionmentioning

confidence: 99%

Outcomes of ultrasound-monitored treatment of divelopmental dysplasia of the hip graf type II

Djoleva¹,

Matveeva²,

Georgieva³

et al. 2022

Sanamed

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Introduction: The management of developmental dysplasia of the hips (DDH) type Graf IIa is still controversial. This study aims to examine the outcomes of ultrasound-monitored Pavlik harness treatment, as well as the effects of associated factors, such as gender, side of DDH, the age at the treatment start, and laterality on the treatment outcomes in different Graf type II subtypes. Methods: A cohort retrospective investigation was performed on 88 ultrasound-screened infants or 125 hips diagnosed with Graf type II dysplasia during a six-month period at a single institution, the University Clinic for Orthopedic Surgery, Skopje. Subsequently, 47 infants (18 boys, 29 girls) or 73 hips who underwent Pavlik harness treatment with at least one follow-up throughout treatment monitoring were included in this study. Results: The treatment success rate of the right DDH Graf type IIa (-) was higher (70.8%) compared to the rate of success (50%) in the treatment of left Graf type IIa (-) hips. The mean age of the infants at the treatment start in successfully treated Graf type IIa (-) hips was lower (9.12 ±2.27 weeks) compared to the age of the infants with treatment failure at the last follow-up (11.33 ±3.06 weeks), P= 0.04.

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“…The hip joint's development is a dynamic process that occurs during the neonatal period and is difficult to assess using direct radiography due to the predominance of cartilage. Hip USG using the Graf classification is the gold standard for detecting DDH in newborns, particularly in the first six months of life [4]. In Türkiye, Graf hip USG screening is a standard method for identifying DDH in newborns and is incorporated into routine newborn evaluations to ensure early detection and treatment of DDH.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Ultrasound Screening Method and Prevalence for Developmental Hip Dysplasia In The Central Anatolia

Pekince,

Sayar,

Ercan

et al. 2024

Pam Tıp Derg

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Objectives:This study aimed to assess the frequency and subsequent results of developmental dysplasia of the hip (DDH) in newborns in Central Anatolia who were admitted to Konya City Hospital and evaluate the efficiency of the existing screening and treatment methods in detecting and managing DDH in infants. Methods: Total of 10,650 infants were evaluated who had Graf USG screening in Konya City Hospital. İnfants born at or after 38 weeks of gestation were included, while premature infants were excluded. Additionally, we included infants who underwent USG screening between 30 and 90 days after birth, and whose hip development physiology was adequately visualized and assessed during the USG examination. Results: The study examined 8,695 term infants (52.5% male, 47.5% female) who underwent USG screening between 2020 and 2022. Participants mean gestational age at the time of the first USG examination was 7.94±2.07 weeks. Graf type 1 was higher in males (%97-96,5) and graf type 2 was higher in females (%7,2-7,8). Radiologists prefer to re-examine after 1 month for type 2a(%84,49-82,02) but orthopaedic consultation for type Type-2B, 2C, and type-3. The majority of infants (93.6%) underwent only one USG screening. No patients who continued regular USG control and treatment required surgical treatment requiring osteotomy. Conclusion: USG is an early diagnostic method for developmental hip dysplasia (DDH), which allows for simple treatment options and prevention of complications. It is a simple, inexpensive, and non-invasive method. Our study supports that regular USG screenings in infants eliminate the need for surgical procedures requiring osteotomy.

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Morphological Development of the Hip in Normal Infants Under Six Months of Age by the Graf Ultrasound Method

Cited by 5 publications

References 23 publications

Incidence of Neonatal Developmental Dysplasia of the Hip and Late Detection Rates Based on Screening Strategy

Incidence of Neonatal Developmental Dysplasia of the Hip and Late Detection Rates Based on Screening Strategy

Outcomes of ultrasound-monitored treatment of divelopmental dysplasia of the hip graf type II

Evaluation of Ultrasound Screening Method and Prevalence for Developmental Hip Dysplasia In The Central Anatolia

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