Treatment of Graf Type IIa Hip Dysplasia: A Cut-off Value for Decision Making
Treatment of Graf Type IIa Hip Dysplasia: A Cut-off Value for Decision Making
Background: The rate of spontaneous normalization in type IIa hipsis 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’sown perspective of physiological immaturity and maturational deficit.Study Design: A single center, retrospective cohort study.Methods: This was an institutional review board-approved retrospectivereview of all patients diagnosed with type IIa hip dysplasia at a singleinstitution from 2012 to 2014. All patients included in the study hadhip ultrasonography at about 6 weeks and 3 months of age. To assessreliability in α and β angles, ultrasonography measurements werecarried out on the same image individually by all observers. The α andβ angles were used as the main outcome measurements to evaluate hipmaturation at the last follow-up. A receiver operating characteristicscurve was drawn at the 3 month ultrasonography to evaluate the cut-offvalues for α and β angles for persistent dysplasia.Results: Sixty-four patients and 88 affected hips (63% unilateral and37% bilateral) were included. The mean age at diagnosis was 6.4±2.7weeks. Fifty-four hips were type IIa(+) (physiologically immature)and 34 hips were type IIa(-) (maturational deficit) at the initialultrasonography evaluation. Improvement to type I was seen in 52type IIa(+) and 17 type IIa(-) hips. Receiver operating characteristicanalyses showed that patients do well if the α angle was >55° (areaunder the curve: 0.86; p
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- 1. Tschauner C, Fürntrath F, Saba Y, Berghold A, Radl R. Developmental dysplasia of
the hip: impact of sonographic newborn hip screening on the outcome of early treated
decentered hip joints-a single center retrospective comparative cohort study based on
Graf's method of hip ultrasonography. J Child Orthop 2011;5:415-24.
- 2. Puhan MA, Woolacott N, Kleijnen J, Steurer J. Observational studies on ultrasound
screening for developmental dysplasia of the hip in newborns - a systematic review.
Ultraschall Med 2003;24:377-82.
- 3. Copuroglu C, Ozcan M, Aykac B, Tuncer B, Saridogan K. Reliability of
ultrasonographic measurements in suspected patients of developmental dysplasia of
the hip and correlation with the acetabular index. Indian J Orthop 2011;45:553-7.
- 4. Omeroglu H. Use of ultrasonography in developmental dysplasia of the hip. J Child
Orthop 2014;8:105-13.
- 5. Graf R. New possibilities for the diagnosis of congenital hip joint dislocation by
ultrasonography. J Pediatr Orthop 1983;3:354-9.
- 6. Dessi A, Crisafulli M, Vannelli E, Fanos V. Ultrasound in developmental dysplasia of
the hip: A screening study in Sardinian newborns. J Ultrasound 2009;12:80-4.
- 7. Omeroğlu H, Caylak R, Inan U, Köse N. Ultrasonographic Graf type IIa hip needs
more consideration in newborn girls. J Child Orthop 2013;7:95-8.
- 8. Graf R. Hip sonography. Diagnosis and management of infant hip dysplasia. Springer,
Berlin: 2006.
- 9. Baronciani D, Atti G, Andiloro F, Bartesaghi A, Gagliardi L, Passamonti C, et
al. Screening for developmental dysplasia of the hip: from theory to practice.
Collaborative Group DDH Project. Pediatrics 1997;99:E5.
- 10. Rosendahl K, Toma P. Ultrasound in the diagnosis of developmental dysplasia of the
hip in newborns. The European approach. A review of methods, accuracy and clinical
validity. Eur Radiol 2007;17:1960-7.
- 11. Roovers EA, Boere-Boonekamp MM, Mostert AK, Castelein RM, Zielhuis GA,
Kerkhoff TH. The natural history of developmental dysplasia of the hip: sonographic
findings in infants of 1-3 months of age. J Pediatr Orthop B 2005;14:325-30.
- 12. Graf R. The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound
treatment. Arch Orthop Trauma Surg 1980;97:117-33.
- 13. Graf R. The ultrasonic image of the acetabular rim in infants. An experimental and
clinical investigation. Arch Orthop Trauma Surg 1981;99:35-41.
- 14. Chan A, McCaul KA, Cundy PJ, Haan EA, Byron-Scott R. Perinatal risk factors for
developmental dysplasia of the hip. Arch Dis Child Fetal Neonatal Ed 1997;76:F94-100.
- 15. Kutlu A, Memik R, Mutlu M, Kutlu R, Arslan A. Congenital dislocation of the hip and
its relation to swaddling used in Turkey. J Pediatr Orthop 1992;12:598-602.
- 16. Kosar P, Ergun E, Gökharman FD, Turgut AT, Kosar U. Follow-up sonographic results
for Graf type 2A hips: association with risk factors for developmental dysplasia of the
hip and instability. J Ultrasound Med 2011;30:677-83.