What is the role of ultrasonography in the workup of developmental dysplasia of the hip (DDH)?

Updated: Feb 26, 2018
  • Author: Junichi Tamai, MD; Chief Editor: William L Jaffe, MD  more...
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Answer

Ultrasonography has been of substantial benefit in the assessment and treatment of children with developmental dysplasia of the hip (DDH). [3, 35, 36, 37] The benefit of screening all children with ultrasonography is controversial. [38, 39] Even with ultrasonographic screening, children with hip dysplasia can be diagnosed late, and one concern with routine ultrasonographic evaluation of newborns is overdiagnosis of hip dysplasia (ie, increased false-positive results). [40]

The use of ultrasonography for only high-risk infants has not yet been shown to reduce the prevalence of late diagnosis of hip dysplasia. [41] However, most authors agree that it is an excellent tool for assessing children with suspected hip instability and a useful aid in the treatment of children with DDH, especially in monitoring reduction by closed methods. [42]

An ultrasound evaluation is typically performed either by assessing the alpha and beta angles or by performing a dynamic evaluation. [35, 37, 43] An alpha angle outlines the slope of the superior aspect of the bony acetabulum, with an angle greater than 60º considered normal. The beta angle, which is considered normal if less than 55º, depicts the cartilaginous component of the acetabulum. Many institutions now use a dynamic form of ultrasonography, as heralded by Harcke. [42]


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