Can developmental dysplasia of the hip be identified in the prenatal period? A pilot study: Ultrasonographic evaluation and postnatal follow-up results of fetal hips in the third trimester

Objective: This study aimed to determine the predictability of developmental dysplasia of the hip (DDH) in the prenatal period by meansof evaluating fetal hips using the Graf method on obstetric ultrasonography (US) after the 34th week of gestation.Methods: A total of 84 pregnant women (mean age = 27.04; age range = 19-46 years), who were referred to our radiology clinic for anobstetric US examination in the third trimester, and their fetuses were included in this study. In the obstetric US, alpha angles of bothhips of the fetuses were measured based on Graf’s method, and each case was assessed ultrasonographically by a second physician at6-10 postnatal weeks. Prenatal and postnatal hips were then classified according to alpha angles as ≥ 60° or < 60°. The kappa coefficientsbetween the diagnoses based on prenatal and postnatal alpha angles were calculated.Results: According to the postnatal alpha angle, 77 fetuses were diagnosed to have type 1 right hip and 7 fetuses had type 2A right hip.The prenatal alpha angle provided the same results (77 type 1 and 7 type 2A right hips). Similarly, the postnatal alpha angle revealed type1 left hip in 82 fetuses and type 2A left hip in 2 fetuses, which was the same as the diagnoses based on the prenatal alpha angles. Therewas a complete agreement between prenatal and postnatal alpha measurements for both the left and right hips (kappa = 1.00, P < 0.001).Conclusion: Evidence from this study has revealed that DDH can be identified by obstetric ultrasonographic examinations in the prenatal period.Level of Evidence: Level II, Diagnostic Study

___

1. Wientroub S, Grill F. Ultrasonography in developmental dysplasia of the hip. J Bone Joint Surg Am. 2000;82-A(7):1004-1018. 10.2106/00004623-200007000- 00012.

2. Graf R. The use of ultrasonography in developmental dysplasia of the hip. Acta Orthop Traumatol Turc. 2007;41(Suppl 1):6-13.

3. Baroti B, Pap Z, Pánti Z, Buruian M. M, Pavai Z. Morphometric and ultrasonographic study of the human fetal hip joint during intrauterine development. Rom J Morphol Embryol. 2013;54(4):977-981.

4. Storer SK, David LS. Developmental dysplasia of the hip. Am Fam Physician. 2006; 74(8):1310-1316.

5. Patel H. Canadian Task Force on Preventive Health Care. Preventive health care, 2001 update: screening and management of developmental dysplasia of the hip in newborns. CMAJ. 2001;164(12):1669-1677.

6. Clarke NM. Role of ultrasound in congenital hip dysplasia. Arch Dis Child. 1994;70(5):362-363. 10.1136/adc.70.5.362.

7. Graf R. Classification of hip joint dysplasia by means of sonography. Arch Orthop Trauma Surg. 1984;102(4):248-255. 10.1007/BF00436138.

8. Beaty JH. Congenital and developmental dysplasia of the hip. In: Canale ST, Beaty JH, Campbell’s Operative Orthopaedics, 11th edition, Mosby. 2007;1180- 1181.

9. Klisic PJ. Congenital dislocation of the hip--a misleading term: brief report. J Bone Joint Surg Br. 1989;71(1):136. 10.1302/0301-620X.71B1.2914985.

10. Connolly P, Weinstein SL. The natural history of acetabular development in developmental dysplasia of the hip. Acta Orthop Traumatol Turc. 2007;41(suppl 1):1-5.

11. Hurley A. DDH: causes and examination: embryology, risk factors and identification of developmental dysplasia of the hip. Community Pract. 2009;82(9):36- 37.

12. Stiegler H, Hafner E, Schuchter K, Engel A, Graf R. A sonographic study of perinatal hip development: from 34 weeks of gestation to 6 weeks of age. J Pediatr Orthop B. 2003;12(6):365-368. 10.1097/01.bpb.0000084466.28647.0e.

13. Finne PH, Dalen I, Ikonomou N, Ulimoen G, Hansen TW. Diagnosis of congenital hip dysplasia in the newborn. Acta Orthop. 2008;79(3):313-320. 10.1080/17453670710015193.

14. Furnes O, Lie SA, Espehaug B, Vollset SE, Engesaeter LB, Havelin LI. Hip disease and the prognosis of total hip replacements. A review of 53,698 primary total hip replacements reported to the Norwegian Arthroplasty Register 1987- 99. J Bone Joint Surg Br. 2001;83(4):579-586. 10.1302/0301-620x.83b4.11223.

15. Jouve JL, Glard Y, Garron E, et al. Anatomical study of the proximal femur in the fetus. J Pediatr Orthop B. 2005;14(2):105-110. 10.1097/01202412- 200503000-00009.

16. Rooker GD. The embryological congruity of the human hip joint. Ann R Coll Surg Engl. 1979;61(5):357-361.

17. Lee J, Jarvis J, Uhthoff HK, Avruch L. The fetal acetabulum. A histomorphometric study of acetabular anteversion and femoral head coverage. Clin Orthop Relat Res. 1992;(281):48-55. 10.1097/00003086-199208000-00009.

18. Whitby EH, Bell MJ, Rigby AS, Burton M. Measuring hip development using magnetic resonance imaging. J Pediatr Orthop. 2007;27(8):898-902. 10.1097/ bpo.0b013e31815a5ff1.

19. Gardiner HM, Clarke NM, Dunn PM. A sonographic study of the morphology of the preterm neonatal hip. J Pediatr Orthop. 1990;10(5):633-637. 10.1097/01241398-199009000-00012.

20. Langer R, Kaufmann HJ. Sonography of thehip inunder weight premature infants. Klin Padiatr. 1987;199(5):373-375. 10.1055/s-2008-1026823.

21. Pinelli G, Senes FM, Asquasciati G, et al. Study of foetal hip: intrauterine positions and sonographic aspects. J Perinat Med. 1994;22(Suppl1):117-120. 10.1515/jpme.1994.22.s1.117.

22. Wagner UA, Gembruch U, Schmitt O, Deimling U, Hansmann M. Ultrasonography studies of the fetal hip. Z Orthop Ihre Grenzgeb. 1994;132(6):497-501. 10.1055/s-2008-1039476.

23. Wagner UA, Gembruch U, Schmitt O, Hansmann M. Technical aspects of ultrasonography of the fetal hip joint. Ultraschall Med. 1994;15(1):33-37. 10.1055/s2007-1004002.

24. Mahan ST, Katz JN, Kim YJ. To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Joint Surg Am. 2009;91(7):1705-1719. 10.2106/JBJS.H.00122.

25. Desprechins B, Ernst C, de Mey J. Screening for developmental dysplasia of the hip. JBR-BTR. 2007;90(1):4-5.