Abstract
According to hip ultrasonography by Graf's method, the type IIa hip has a certain degree of physiological delay in ossification of the bony acetabular roof. The aim of this case-control study was to evaluate the natural history of the type IIa hip. Four hundred and thirty-one type IIa hips were identified in 312 of 1,690 ultrasonographically screened newborns with a mean age of 27days. Parents were accurately informed about the prognosis of such a hip condition and invited for ultrasonographic re-examination at 6-7weeks of age. Type IIa hip was more common in newborn girls than in boys (P<0.001). Among 431 type IIa hips, 146 (34%) missed the follow-up examination at 6-7weeks of age. Among the completely followed 285 hips, 225 (79%) developed into a normal hip at 6-7weeks of age. Newborn boys' hips had a higher rate of spontaneous normalization than girls' hips at 6-7weeks of age (P=0.006). All but one type IIa(+) hip became type I without any treatment. According to our management protocol, 35 type IIa(-) hips and one type IIa(+) hip, which later became type IIb, underwent treatment. The rate of treatment was higher in newborn girls' hips than in boys' hips (P=0.019). As Graf type IIa hip is more common, has a lower rate of spontaneous normalization and higher rate of treatment in newborn girls than in boys, we recommend paying more attention the type IIa hip in newborn girls. The rate of missing the required follow-up is unacceptably high due to parents' insensitivity regarding the type IIa hip.
Highlights
Developmental dysplasia of the hip (DDH) has no single causative factor, but familial predisposition, prenatal and postnatal mechanical factors, racial predilection and gender are the well-known predisposing factors [1, 2]
Type IIa hip was more common in newborn girls than in boys (P \ 0.001)
When we identify a type IIa hip at 3–4 weeks of age, we warn the parents that such a hip usually reaches normality by 12 weeks of age, but at least one ultrasonographic re-examination is needed at 6–7 weeks of age in order not to miss a possible failure in normal hip maturation that can lead to a true hip dysplasia
Summary
Developmental dysplasia of the hip (DDH) has no single causative factor, but familial predisposition, prenatal and postnatal mechanical factors, racial predilection and gender (girls have 5–8 times higher incidence) are the well-known predisposing factors [1, 2]. Most of the authors agree that female newborns and newborns of either sex having a history of family members with DDH, breech presentation, torticollis, foot deformities or oligohydroamnios should have more careful newborn hip screening [1]. Hip ultrasonography (USG) provides early detection of DDH by visualizing both the bony and cartilaginous parts of the newborn hip joint [3]. The risk of missing the DDH diagnosis by hip USG is less than 0.1 % [4]. Graf initially described the use of infantile hip USG for the early diagnosis of DDH in the early 1980s [5], and his method has been the most widely used since . According to Graf’s method, bony roof (alpha) angle mainly determines the hip type. Cartilaginous roof (beta) angle, age of the patient and the course of the perichondrium are additional determining issues of ultrasonographic hip
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