Treatment of Graf Type IIa Hip Dysplasia: A Cutoff Value for Decision Making

Abstract

Background:The rate of spontaneous normalization in type IIa hips is reported to be high, whereas dysplsia persists or worsens in 5%-10% of cases.Aims:To evaluate the natural course of type IIa hips using Graf’s own perspective of physiological immaturity and maturational deficit.Study Design:A single center, retrospective cohort study.Methods:This was an institutional review board-approved retrospective review of all patients diagnosed with type IIa hip dysplasia at a single institution from 2012 to 2014. All patients included in the study had hip ultrasonography at about 6 weeks and 3 months of age. To assess reliability in α and β angles, ultrasonography measurements were carried out on the same image individually by all observers. The α and β angles were used as the main outcome measurements to evaluate hip maturation at the last follow-up. A receiver operating characteristics curve was drawn at the 3 month ultrasonography to evaluate the cut-off values for α and β angles for persistent dysplasia.Results:Sixty-four patients and 88 affected hips (63% unilateral and 37% bilateral) were included. The mean age at diagnosis was 6.4±2.7 weeks. Fifty-four hips were type IIa(+) (physiologically immature) and 34 hips were type IIa(-) (maturational deficit) at the initial ultrasonography evaluation. Improvement to type I was seen in 52 type IIa(+) and 17 type IIa(-) hips. Receiver operating characteristic analyses showed that patients do well if the α angle was >55° (area under the curve: 0.86; p<0.001 for the left hip and area under the curve: 0.72; p=0.008 for the right hip).Conclusion:The cut-off α angle value of 55° on initial ultrasonography should be considered to prevent future dysplasia. An α angle <55° on the initial ultrasonography was an independent predictor of worsening sonographic findings.

Does the COVID‐19 pandemic cause late diagnosis and delay in treatment in developmental dysplasia of hip patients?

“…The Graff's method has been widely used in US for the diagnosis of DDH since the 1980s. 9 Although there are various differences of opinion about the time of neonatal US in the literature, everyone agrees that neonatal US and initiation of the treatment should be performed in the first 3 months of life. 4 Late diagnosis may result in delayed treatment, decreasing the success of conservative treatments, increasing the need for surgery.…”

Developmental Dysplasia of the Hip: Management of Graf IIa Dysplastic Hip

“…Type IIa(+) hips are still within the acceptable limits for age. If a type IIa hip does not reach the minimum linear maturation rate, then it Pediatrics girls, as its natural history is not as good in girls as in boys[23].…”

The incidence of avascular necrosis following a cohort of treated developmental dysplasia of the hip in a single tertiary centre

“…Although these hips are well known to spontaneously resolve with no treatment, dysplasia may persist in 5% to 10% of cases. [ 19 ] The literature is very limited on this treatment modality and the authors acknowledge that further studies should be carried out to determine its success rate.…”