Skip to main content
Log in

Ultrasound in the diagnosis of developmental dysplasia of the hip in newborns. The European approach. A review of methods, accuracy and clinical validity

European Radiology Aims and scope Submit manuscript

Abstract

Based on soft evidence that ultrasound screening tends to reduce the rate of late developmental dysplasia of the hip (DDH) and the need for surgical interventions, different screening strategies including universal or selective ultrasound screening have been established in several European countries and centres during the last decade. We performed an extensive search for articles on ultrasound diagnosis of developmental dysplasia of the hip over the last 26 years. A few studies reported an adequate repeatability for the static [Graf, Morin, modified Morin (Terjesen)] and for the combined static/dynamic methods [modified Graf (Rosendahl)], while no such reports were found for the dynamic (Harcke) ultrasound techniques. The effect of newborn ultrasound screening on late DDH have been addressed in two randomised trials (RCTs), both concluding that both selective and universal ultrasound screening tend to reduce the prevalence of subluxed or dislocated DDH, thus without reaching statistical significance. Finally, several observational studies have shown that morphologically normal hips tend to remain normal with or without a co-existing instability, and 97% of sonographically immature hips tend to normalise spontaneously within 3 months. Two studies report on a similar pattern for mildly dysplastic, but stable hips. From the data available we suggest that selective ultrasound screening is worthwhile in areas with a high prevalence of late cases, given a well-organised, high-quality service can be provided.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Paton RW, Hossain S, Eccles K (2002) Eight-year prospective targeted ultrasound screening program for instability and at-risk hip joints in developmental dysplasia of the hip. J Pediatr Orthop 22:338–341

    Article  PubMed  Google Scholar 

  2. Roovers EA, Boere-Boonekamp MM, Castelein RM, Zielhuis GA, Kerkhoff TH (2005) Effectiveness of ultrasound screening for developmental dysplasia of the hip. Arch Dis Child Fetal Neonatal Ed 90:F25–F30

    Article  PubMed  CAS  Google Scholar 

  3. Holen KJ, Tegnander A, Bredland T, Johansen OJ, Saether OD, Eik-Nes SH, Terjesen T (2002) Universal or selective screening of the neonatal hip using ultrasound? A prospective, randomised trial of 15,529 newborn infants. J Bone Joint Surg Br 84:886–890

    Article  PubMed  CAS  Google Scholar 

  4. Rosendahl K, Markestad T, Lie RT (1994) Ultrasound screening for developmental dysplasia of the hip in the neonate: the effect on treatment rate and prevalence of late cases. Pediatrics 94:47–52

    PubMed  CAS  Google Scholar 

  5. Eggl H, Krismer M, Klestil T, Frischhut B (1993) Auswirkungen des Huftsonographiescreenings. Eine epidemiologische Studie. Orthopade 22:277–279

    PubMed  CAS  Google Scholar 

  6. Harcke HT (1994) Screening newborns for developmental dysplasia of the hip: the role of sonography. AJR Am J Roentgenol 162:395–397

    PubMed  CAS  Google Scholar 

  7. Boeree NR, Clarke NM (1994) Ultrasound imaging and secondary screening for congenital dislocation of the hip. J Bone Joint Surg Br 76:525–533

    PubMed  CAS  Google Scholar 

  8. Rosendahl K, Markestad T, Lie RT (1992) Ultrasound in the early diagnosis of congenital dislocation of the hip: the significance of hip stability versus acetabular morphology. Pediatr Radiol 22:430–433

    Article  PubMed  CAS  Google Scholar 

  9. Graf R (2002) Huftsonographie. Ein Update. Orthopade 31:181–189

    Article  PubMed  CAS  Google Scholar 

  10. Graf R, Tschauner C, Steindl M (1987) Ist die IIa-Hufte behandlungsbedurftig? Ergebnisse einer Langsschnittuntersuchung sonographisch kontrollierter Sauglingshuften unter dem 3. Lebensmonat. Monatsschr Kinderheilkd 135:832–837

    PubMed  CAS  Google Scholar 

  11. Lehmann HP, Hinton R, Morello P, Santoli J (2000) Developmental dysplasia of the hip practice guideline: technical report. Committee on Quality Improvement, and Subcommittee on Developmental Dysplasia of the Hip. Pediatrics 105:E57

    Article  PubMed  CAS  Google Scholar 

  12. Toma P, Valle M, Rossi U, Brunenghi GM (2001) Paediatric hip-ultrasound screening for developmental dysplasia of the hip: a review. Eur J Ultrasound 14:45–55

    Article  PubMed  CAS  Google Scholar 

  13. Patel H (2001) Preventive health care, 2001 update: screening and management of developmental dysplasia of the hip in newborns. Can Med Assoc J 164:1669–1677

    CAS  Google Scholar 

  14. Shipman SA, Helfand M, Moyer VA, Yawn BP (2006) Screening for Developmental Dysplasia of the hip: a systematic literature review for the US Preventive Services Task Force. Pediatrics 117:557–576

    Article  Google Scholar 

  15. Dunn PM, Evans RE, Thearle MJ, Griffiths HE, Witherow PJ (1985) Congenital dislocation of the hip: early and late diagnosis and management compared. Arch Dis Child 60:407–414

    PubMed  CAS  Google Scholar 

  16. Bjerkreim I (1974) Congenital dislocation of the hip joint in Norway. I. Late-diagnosis CDH. Acta Orthop Scand Suppl 157:1–20

    PubMed  CAS  Google Scholar 

  17. Bialik V, Fishman J, Katzir J, Zeltzer M (1986) Clinical assessment of hip instability in the newborn by an orthopedic surgeon and a pediatrician. J Pediatr Orthop 6:703–705

    PubMed  CAS  Google Scholar 

  18. Heikkila E, Ryoppy S (1984) Treatment of congenital dislocation of the hip after neonatal diagnosis. Acta Orthop Scand 55:130–134

    Article  PubMed  CAS  Google Scholar 

  19. Stamnes O, Markestad T, Hole J, Seime S (1986) Hofteleddsluksasjon hos nyfodte. Et diagnostisk problem. Tidsskr Nor Laegeforen 106:2607–2609

    PubMed  CAS  Google Scholar 

  20. von Kries R, Ihme N, Oberle D, Lorani A, Stark R, Altenhofen L, Niethard FU (2003) Effect of ultrasound screening on the rate of first operative procedures for developmental hip dysplasia in Germany. Lancet 362:1883–1887

    Article  Google Scholar 

  21. Kohler G, Hell AK (2003) Experiences in diagnosis and treatment of hip dislocation and dysplasia in populations screened by the ultrasound method of Graf. Swiss Med Wkly 133:484–487

    PubMed  CAS  Google Scholar 

  22. Grill F, Muller D (1997) Ergebnisse des Huftultraschallscreenings in Osterreich. Orthopade 26:25–32

    PubMed  CAS  Google Scholar 

  23. Brown J, Dezateux C, Karnon J, Parnaby A, Arthur R (2003) Efficiency of alternative policy options for screening for developmental dysplasia of the hip in the United Kingdom. Arch Dis Child 88:760–766

    Article  PubMed  CAS  Google Scholar 

  24. Falliner A, Hahne HJ, Hassenpflug J (1999) Sonographic hip screening and early management of developmental dysplasia of the hip. J Pediatr Orthop B 8:112–117

    PubMed  CAS  Google Scholar 

  25. Roovers EA, Boere-Boonekamp MM, Mostert AK, Castelein RM, Zielhuis GA, Kerkhoff TH (2005) The natural history of developmental dysplasia of the hip: sonographic findings in infants of 1–3 months of age. J Pediatr Orthop B 14:325–330

    PubMed  Google Scholar 

  26. Graf R (1980) The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch Orthop Trauma Surg 97:117–133

    Article  PubMed  CAS  Google Scholar 

  27. Ganger R, Grill F, Leodolter S, Vitek M (1991) Ultraschallscreening der Neugeborenenhufte: Ergebnisse und Erfahrungen. Ultraschall Med 12:25–30

    PubMed  CAS  Google Scholar 

  28. Berman L, Klenerman L (1986) Ultrasound screening for hip abnormalities: preliminary findings in 1001 neonates. Br Med J (Clin Res Ed) 293:719–722

    Article  CAS  Google Scholar 

  29. Langer R (1987) Ultrasonic investigation of the hip in newborns in the diagnosis of congenital hip dislocation: classification and results of a screening program. Skeletal Radiol 16:275–279

    Article  PubMed  CAS  Google Scholar 

  30. Tonnis D, Storch K, Ulbrich H (1990) Results of newborn screening for CDH with and without sonography and correlation of risk factors. J Pediatr Orthop 10:145–152

    PubMed  CAS  Google Scholar 

  31. Exner GU (1988) Ultrasound screening for hip dysplasia in neonates. J Pediatr Orthop 8:656–660

    PubMed  CAS  Google Scholar 

  32. Baronciani D, Atti G, Andiloro F, Bartesaghi A, Gagliardi L, Passamonti C, Petrone M (1997) Screening for developmental dysplasia of the hip: from theory to practice. Collaborative Group DDH Project. Pediatrics 99:E5

    Article  PubMed  CAS  Google Scholar 

  33. Schule B, Wissel H, Neumann W, Merk H (1999) Verlaufskontrollen von Huftbefunden im sonographischen Neugeborenenscreening. Ultraschall Med 20:161–164

    Article  PubMed  CAS  Google Scholar 

  34. Rosendahl K, Markestad T, Lie RT (1996) Developmental dysplasia of the hip: prevalence based on ultrasound diagnosis. Pediatr Radiol 26:635–639

    Article  PubMed  CAS  Google Scholar 

  35. Harcke HT, Clarke NM, Lee MS, Borns PF, MacEwen GD (1984) Examination of the infant hip with real-time ultrasonography. J Ultrasound Med 3:131–137

    PubMed  CAS  Google Scholar 

  36. Morin C, Harcke HT, MacEwen GD (1985) The infant hip: real-time US assessment of acetabular development. Radiology 157:673–677

    PubMed  CAS  Google Scholar 

  37. Terjesen T, Bredland T, Berg V (1989) Ultrasound for hip assessment in the newborn. J Bone Joint Surg Br 71:767–773

    PubMed  CAS  Google Scholar 

  38. Holen KJ, Terjesen T, Tegnander A, Bredland T, Saether OD, Eik-Nes SH (1994) Ultrasound screening for hip dysplasia in newborns. J Pediatr Orthop 14:667–673

    PubMed  CAS  Google Scholar 

  39. Marks DS, Clegg J, al Chalabi AN (1994) Routine ultrasound screening for neonatal hip instability. Can it abolish late-presenting congenital dislocation of the hip? J Bone Joint Surg Br 76:534–538

    PubMed  CAS  Google Scholar 

  40. Novick G, Ghelman B, Schneider M (1983) Sonography of the neonatal and infant hip. AJR Am J Roentgenol 141:639–645

    PubMed  CAS  Google Scholar 

  41. Rosenberg N, Bialik V, Norman D, Blazer S (1998) The importance of combined clinical and sonographic examination of instability of the neonatal hip. Int Orthop 22:185–188

    Article  PubMed  CAS  Google Scholar 

  42. De Pellegrin M (1991) Ultrasound screening for congenital dislocation of the hip. Results and correlations between clinical and ultrasound findings. Ital J Orthop Traumatol 17:547–553

    PubMed  Google Scholar 

  43. Riboni G, Bellini A, Serantoni S, Rognoni E, Bisanti L (2003) Ultrasound screening for developmental dysplasia of the hip. Pediatr Radiol 33:475–481

    Article  PubMed  Google Scholar 

  44. Ortore P, Fodor G, Silverio R, Milani C, Psenner K (1996) Ecografia dell’anca neonatale: stato dell’arte e prospettive. Radiol Med (Torino) 92:10–15

    CAS  Google Scholar 

  45. Schilt M (2001) Optimaler Zeitpunkt des Huftsonographie-Screenings. Ultraschall Med 22:39–47

    Article  PubMed  CAS  Google Scholar 

  46. Baronciani D, Atti G, Andiloro F, Bartesaghi A, Gagliardi L, Passamonti C, Petrone M (1997) Screening for developmental dysplasia of the hip: from theory to practice. Collaborative Group DDH Project. Pediatrics 99:E5

    Article  PubMed  CAS  Google Scholar 

  47. Elbourne D, Dezateux C, Arthur R, Clarke NM, Gray A, King A, Quinn A, Gardner F, Russell G (2002) Ultrasonography in the diagnosis and management of developmental hip dysplasia (UK Hip Trial): clinical and economic results of a multicentre randomised controlled trial. Lancet 360:2009–2017

    Article  PubMed  Google Scholar 

  48. Zieger M (1986) Ultrasound of the infant hip. Part 2. Validity of the method. Pediatr Radiol 16:488–492

    Article  PubMed  CAS  Google Scholar 

  49. Roovers EA, Boere-Boonekamp MM, Geertsma TS, Zielhuis GA, Kerkhoff AH (2003) Ultrasonographic screening for developmental dysplasia of the hip in infants. Reproducibility of assessments made by radiographers. J Bone Joint Surg Br 85:726–730

    PubMed  CAS  Google Scholar 

  50. Rosendahl K, Aslaksen A, Lie RT, Markestad T (1995) Reliability of ultrasound in the early diagnosis of developmental dysplasia of the hip. Pediatr Radiol 25:219–224

    Article  PubMed  CAS  Google Scholar 

  51. Andersson JE (1995) Neonatal hip instability: normal values for physiological movement of the femoral head determined by an anterior-dynamic ultrasound method. J Pediatr Orthop 15:736–740

    PubMed  CAS  Google Scholar 

  52. Bar-On E MSHGPS (1998) Ultrasonography of the hip in developmental hip dysplasia. J Bone Surg Br 80(2):321–324

    Article  CAS  Google Scholar 

  53. Dorn U, Hattwich M (1987) Erste Erfahrungen mit der routinemassig durchgefuhrten Huftsonographie bei Neugeborenen. Wien Klin Wochenschr 99:92–95

    PubMed  CAS  Google Scholar 

  54. Reikeras O, Kristiansen LP, Gunderson R (2002) Ultrasonography of the infant hip: the significance of provokable instability with normal morphology. Orthopedics 25:833–835

    PubMed  Google Scholar 

  55. Knapp-Birzle P (1989) Der Einfluss der Sonographie auf Diagnose, Therapie und Verlauf der angeborenen Huftdysplasie and Huftluxation. Dissertation. Munchen Universitet, 1989

  56. Schmitz A, Wagner UA, Schmitt O (1999) Die Behandlung der grenzwertigen D/IIIa-Hufte beim Neugeborenen mit der Graf-Mittelmeier-Aktivspreizhose unter engmaschiger sonographischer Kontrolle. Z Orthop Ihre Grenzgeb 137:400–402

    Article  PubMed  CAS  Google Scholar 

  57. Sampath JS, Deakin S, Paton RW (2003) Splintage in developmental dysplasia of the hip: how low can we go? J Pediatr Orthop 23:352–355

    Article  PubMed  Google Scholar 

  58. Wood MK, Conboy V, Benson MK (2000) Does early treatment by abduction splintage improve the development of dysplastic but stable neonatal hips? J Pediatr Orthop 20:302–305

    Article  PubMed  CAS  Google Scholar 

  59. (1992) Conference de consensus sur le dépistage de la luxation congénitale de hanche. Paris, 4 Novembre 1991. Rev Prat 15:1011

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Karen Rosendahl.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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 17, 1960–1967 (2007). https://doi.org/10.1007/s00330-006-0557-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-006-0557-y

Keywords

Navigation