Ultrasound evaluation of Developmental Dysplasia of the Hip: A review of the many classification methods.

Congress:

ECR 2020

Poster Number:

C-08463

Type:

Educational Exhibit

Keywords:

Performed at one institution, Not applicable, Education and training, Dysplasias, Technical aspects, Education, Diagnostic procedure, Ultrasound, Paediatric, Musculoskeletal joint, Anatomy

Authors:

J. K. Soares¹, M. S. Takahashi¹, F. Gual², T. D. GASPARETTO¹, G. MOTTA³, M. T. Moreira³, L. B. Q. Rodrigues ³; ¹Sao Paulo/BR, ²São José do Rio Preto/BR, ³SÃO PAULO/BR

DOI:

10.26044/ecr2020/C-08463

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-08463

Fig. 1: The broad spectrum of hip developmental changes, ranging from physiologic...

Fig. 2: Graf method technique, showing the correct positions of both patient and probe...

Fig. 3: Three important references that must be well represented at the ultrasound...

Fig. 17: The technique of the Harcke method, showing the correct positions of both...

Learning objectives

The purpose of this exhibit is to: do an overview of incidence, risk factors, and physiopathology of DDH; teach the normal and abnormal hip anatomy on 2D and 3D ultrasound; review the many different ultrasound techniques and classification methods; present and explain how to avoid common pitfalls.

Background

Developmental Dysplasia of the Hip (DDH) makes up a broad spectrum of hip developmental changes, ranging from immature hips (whose acetabulum may be slightly shallower, but which maintains stability) to more severe cases (where the acetabulum is very shallow with the instability of the femoral head) ( Fig. 1 ). Teratologic hip dysplasia is a special category of dislocation seen in newborn babies with an underlying neuromuscular condition, in which the hip is dislocated early in gestation leading to advanced acetabular and femoral changes. DDH...

Findings and procedure details

Ultrasonography has been used since the 1980s for the evaluation of DDH: Safe and non-invasive; Easy repeatability; Good anatomical evaluation of the joint that is not yet fully ossified; Relatively low cost. See below, the main ultrasound methods used nowadays. These methods are not exclusive and can be used together for more complete hip evaluation. Graf Method The static method described by Reinhard Graf in 1990. It uses only one coronal plane. Classification based on alpha and beta angles (Fig. 9 - Fig. 10). Patient...

Conclusion

DDH ranges from self-limiting to structural changes that if not properly treated can progress to early joint degeneration. There are several methods for assessing DDH, but none is universally accepted. However, they can be used together for a more complete hip assessment.

Personal information and conflict of interest

J. Kanashiro; Sao Paulo/BR - nothing to disclose M. S. Takahashi; Sao Paulo/BR - nothing to disclose T. P. Davaus Gasparetto; São Paulo/BR - nothing to disclose F. Gual; São José do Rio Preto/BR - nothing to disclose M. T. Moreira; São Paulo/BR - nothing to disclose G. Motta; SÃO PAULO/BR - nothing to disclose L. B. Q. Rodrigues; SÃO PAULO/BR - nothing to disclose

References

Harcke HT et al. Performing dynamic sonography of the infant's hip. AJR Am J Roentgenol. 1990;155(4):837-844. Graf R. Fundamentals of sonographic diagnosis of infant hip dysplasia. J Pediatr Orthop. 1984;4(6):735-740. Couture A. et al. Ultrasound of the neonatal hip: initial evaluation and follow-up. J Radiol. 2011;92(2):142-165. Treguier C., et al. Pubo-femoral distance: an easy sonographic screening test to avoid the late diagnosis of developmental dysplasia of the hip. Eur Radiol. 2013;23(3):836-844. Terjesen T. Ultrasound as the primary imaging method in the diagnosis of hip dysplasia...