Graf Method Research Articles

ECAD study: Evaluating agreement degree among paediatricians in hip dysplasia assessment by the Graf ultrasound method.

Developmental dysplasia of the hip (DDH) is the most common musculoskeletal anomaly of childhood. This study analyses paediatrician's concordance performing hip ultrasound according to Graf's method. An analytical cross-sectional study is designed. Patients' hips are evaluated by Graf's ultrasound method at 4-6 and 12-16weeks of age. Demographic characteristics, pregnancy history, factors related to DDH, hip type, and α and β angles are collected. To assess the agreement degree of hip diagnosis and hip types Kappa index (I. kappa) is used. Intraclass correlation coefficient (ICC) evaluates the concordance of α and β angles. A p value < 0.05 is considered statistically significant. All results are represented with their 95% confidence interval (95% CI). Four hundred sixty-seven neonates are recruited and meet the inclusion criteria. A total of 3182 images were analysed. Agreement between paediatricians according to hip diagnosis and different types ranges from moderate to almost perfect I. kappa 0.6-1.0 (95% CI 0.5-0.7; 95% CI 1.0-1.0). α angle ICC for paediatricians is between 0.75 and 0.88 (95% CI 0.61-0.86; 95% CI 0.80-0.92). β angle value agreement degree among paediatricians at both visits is moderate. The Graf method is the most popular ultrasound technique for hip assessment. In our setting, paediatricians carry out children follow-up; therefore, they should perform universal screening. In this study agreement degree between paediatricians varies between substantial and almost perfect. Conclusion: The Graf ultrasound procedure performed by paediatricians is a reliable test and can be used for DDH screening. What is Known •Developmental dysplasia of the hip (DDH) is the most common congenital musculoskeletal anomaly of childhood. Early diagnosis and treatment improve DDH prognosis. Lack of detection can cause complications such as lameness, early osteoarthritis and need for hip replacement at an early age. What is New •Today, the best screening method is still subject of debate. But it seems that with selective screening many pathological hips go unnoticed. Universal screening implementation may be a challenge in some countries. But the question is if this could be carried out by paediatricians as part of healthy child follow-up.

The Feasibility of Prenatal Ultrasonic Screening for Developmental Dysplasia of the Hip.

developmental dysplasia of the hip (DDH) is a condition characterized by abnormal hip development in infancy. Early diagnosis allows for effective treatment, while late presentation often necessitates complex surgical interventions. Current recommendations advise screening between the 6th and 8th week postnatal using an ultrasound, typically employing the Graf method. However, there is no universal consensus on whether ultrasound screening significantly increases treatment likelihood compared to clinical examination-guided ultrasound. This study aims to explore the feasibility of prenatal ultrasound for the early identification of DDH risk. This prospective observational study involved 100 pregnant women undergoing fetal hip ultrasounds during the second and third trimesters. Using the modified Graf method, alpha and beta angles were calculated on the fetus. Postnatally, alpha and beta angles were compared with the prenatal values. Prenatal ultrasound at the 24th week showed inconclusive results because of the difficulty in identification of Graf landmarks, while ultrasound at the 34th week proved to be a reliable and safe method for the quantitative determination of alpha and beta angles. Significant correlations were found between prenatal and postnatal alpha and beta angles. Moreover, significant differences in prenatal alpha and beta values were observed in patients developing mature/immature hips postnatally. Prenatal diagnostics show promise for predicting infant hip development. Further research is warranted to validate correlation strength and clinical applicability.

Involution Transformer Based U-Net for Landmark Detection in Ultrasound Images for Diagnosis of Infantile DDH.

The B-mode ultrasound based computer-aided diagnosis (CAD) has demonstrated its effectiveness for diagnosis of Developmental Dysplasia of the Hip (DDH) in infants, which can conduct the Graf's method by detecting landmarks in hip ultrasound images. However, it is still necessary to explore more valuable information around these landmarks to enhance feature representation for improving detection performance in the detection model. To this end, a novel Involution Transformer based U-Net (IT-UNet) network is proposed for hip landmark detection. The IT-UNet integrates the efficient involution operation into Transformer to develop an Involution Transformer module (ITM), which consists of an involution attention block and a squeeze-and-excitation involution block. The ITM can capture both the spatial-related information and long-range dependencies from hip ultrasound images to effectively improve feature representation. Moreover, an Involution Downsampling block (IDB) is developed to alleviate the issue of feature loss in the encoder modules, which combines involution and convolution for the purpose of downsampling. The experimental results on two DDH ultrasound datasets indicate that the proposed IT-UNet achieves the best landmark detection performance, indicating its potential applications.

Universal ultrasound screening and early treatment of developmental dysplasia of the hip: a critical review.

Developmental dysplasia of the hip (DDH) is the most common musculoskeletal disease in infants, and delayed diagnosis can worsen the prognosis. Clinical evidence increasingly supports universal ultrasound (US) screening over selective US screening. The Graf method remains the most widely accepted US technique. Performing an US screening at one month of age seems appropriate as it allows for some hip maturity and early detection, thereby increasing the chances of a favorable outcome. This paper presents an approach to US findings based on the femoral head coverage method. Considering the long-term cost and psychosocial impact of missed DDH cases, universal ultrasound screening appears to be a cost-effective alternative.

A systematic review of DDH screening practices in the UK

Background: The United Kingdom (UK) currently employs a selective screening system for developmental dysplasia of the hip (DDH). Despite this, late presentation rates remain high. The aim of this study was to systematically review the available literature to gain an understanding of screening practices throughout the UK. Methods: A systematic review was conducted. Studies reporting DDH screening methods from the UK were included. The primary outcome measure was the method of ultrasound and clinical screening. Secondary outcomes were the treatment rate and late presentation rate. A narrative analysis was undertaken, as meta-analysis was felt to be inappropriate due to the differences between included studies. Results: Nine studies were eligible and included. There was significant variability in practice, with a variety of ultrasound techniques being used and a variety of staff members performing clinical screening. Treatment rate ranged from 16.4/1,000 to 0.8/1,000. Late presentation rate ranged from 1.28/1,000 to 0.27/1,000. Discussion: In spite of a national consensus statement, there is no standardised approach to clinical or ultrasound screening in the UK. A variety of different methods are used, which may explain the persistently high late presentation rate. A national system of quality control and a standardised screening process is recommended, with specialised training in the Graf method of ultrasound.

Результаты ультразвукового скрининга дисплазии тазобедренных суставов у детей грудного возраста

Hip dysplasia (HD) represents the congenital underdevelopment of the hip joint (HJ) being the most common orthopedic problem of newborns having the prevalence of 5–20%. Late HD detection is the main cause of coxarthrosis in young adulthood. The study was aimed to assess the results of ultrasound screening for HD in infants. The study involved 860 full-term infants aged 1–3 months (446 boys (51.9%) and 414 girls (48.1%)). All newborns underwent ultrasound imaging of the hip joint at the age of 1 month and the follow-up examination at the age of 3 months (Graf method). The χ2 test and p &lt; 0.05 were used to compare the data. In their first year of life, 685 newborns (79.7%) had joints of normal or transitory shape, 161 (18.7%) showed physiological immaturity and 14 (1.6%) showed the HJ abnormality; the HJ immaturity and abnormality were more prevalent in girls (113 cases (26.3%)) than in boys (62 cases (13.9%)). The relationship between the breech presentation and the likelihood of developing HD was revealed (p &lt; 0.001). Spontaneous improvement by the age of 3 months took place in the majority of infants having the ultrasound signs of HD, the rate of normal HJ increased from 79.8 to 94.5%. Ultrasound screening is an effective method allowing one to detect HD starting from the first days of the child’s life. The risk factors of HD are still female sex and breech presentation, regardless of the number of births. Spontaneous improvement following prescription of relaxing massage occurs in the majority of children.

Screening of Developmental Dysplasia of the Hip in Europe: A Systematic Review.

Developmental dysplasia of the hip (DDH) is a prevalent orthopaedic disorder in children, and screening methods vary across regions due to local health policies. The purpose of this review is to systematise the different ultrasound screening strategies for detecting DDH in newborns in Europe. Eligible studies from the PubMed, Embase, and Scopus databases, published between 1 January 2018 and 18 March 2023, were included. The inclusion criteria specified a European origin, a focus on newborn human patients, and information on ultrasound for DDH detection. In total, 45 studies were included, covering 18 countries. Among them, six nations (Austria, Bosnia and Herzegovina, Poland, Slovenia, the Czech Republic, and Germany) perform universal ultrasound screening. The timing of the first ultrasound varies, with Austria and the Czech Republic within the 1st week, Bosnia and Herzegovina on the day of birth, Poland between 1 and 12 weeks, and Germany before the 6th week. The Graf method is the most popular ultrasound technique used. There is no consensus on the optimal DDH detection approach in Europe. Varied screening methods stem from epidemiological, cultural, and economic differences among countries.

Ultrasound Evaluation of Congenital Hip Dislocation and Other Parameters in Children

Introduction: Congenital hip dislocation is caused by a wide spectrum of reasons, leading to disability among children. Many factors contribute to the disorder, including breech presentation, consanguineous marriage, and the hormone (Relaxin) which can promote ligament laxity in some patients with congenital hip dislocation. Additionally, being a firstborn child is said to increase the risk of developing the condition. The preferred method for assessing the hip in infants under 6 months of age is ultrasound (US). The Graf method is widely utilized among the various US screening techniques for the hip joint in this age group. The purpose of the study was to demonstrate the importance of ultrasonic imaging as a screening and diagnostic tool for congenital hip dislocation (CHD).

Universal Ultrasound Screening for Developmental Dysplasia of the Hip Among Infants in Community Settings in Japan: A Scoping Review.

Early identification of developmental dysplasia of the hip (DDH) is necessary to minimize its negative effects. Ultrasound screening is useful for detecting DDH in hospitals. Awareness about community-based screening systems is low in Japan. Despite established nationwide home visiting services and child health checkups in the country, more than 10% of DDH patients are diagnosed at the age of ≥1 year. This review aimed to clarify the status of universal ultrasound screening for DDH among infants in community settings in Japan. The electronic databases of Igaku Chuo Zasshi, MEDLINE, CHINAL, ERIC, and APA PsycInfo were searched for articles published between 2002 and 2022. Articles were evaluated with the reach, effectiveness, adoption, implementation, and maintenance framework. In total, 148 articles were identified. Two articles were manually added, and 67 articles were excluded through abstract reviews, of which 20 were duplicates. Finally, 18 articles were included in the analysis. There are two types of universal ultrasound screening in community settings: municipality-led and hospital-led. Since 1992, municipality-led screening has been conducted during public infant health checkups in five municipalities. Six hospitals implemented ultrasound screening. The participation rate was around 90%. The Graf method is typically used for this purpose. The prevalence of abnormal hips was 3.6%-16.6%. Owing to limited human resources and skills in ultrasound, all studies mentioned the necessity of a universal screening system for the early detection of DDH. Embedding universal ultrasound screening in community health checkup systems enables collaboration between healthcare professionals and caregivers to improve health inequities and ensure early detection of DDH cases.

The risk of DDH between breech and cephalic-delivered neonates using Graf ultrasonography.

Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal disorder in infants. The most significant risk factors include female gender, breech presentation, left hip and family history. In this study, we utilized the Graf method at different time intervals to evaluate both breech-delivered and cephalic-born newborns. The objectives were to compare the incidence of DDH in cephalic and breech-delivered neonates and investigate whether the hip joints of neonates delivered in the breech position exhibit a distinct maturation pattern. We studied prospectively 618 hip joints (309 newborns). Each hip joint was examined with the Graf method in four time periods as follows: Phase #1 (0-1weeks), Phase #2 (1-4weeks), Phase #3 (4-7weeks), and Phase #4 (7-10weeks). The α and β angles for each hip joint were measured, and the hips were classified according to Graf classification. With our statistical analysis within the different phases, we were able to investigate potential variations in the maturation patterns between newborns delivered in the breech and cephalic delivery positions. A significant difference (at the 5% level) was observed in Phase 1 between breech and cephalic-delivered neonates (35.6-8.6%). This difference tended to decrease in next phases (13.6-1% in Phase 2, 2.5-0% in Phase 3 and 1.7-0% in Phase 4). A significant difference (at the 5% level) for cephalic-delivered neonates was also observed between Phase 1 and Phase 4 (8.5-0%), but the percentages were low. Additionally, the breech-delivered had extreme difference in incidence of DDH from Phase 1 to Phase 4 (35.6-11.9%, 2.5%, and 1.7%, respectively). It appears that there is an actual difference in the incidence of DDH between breech-delivered and cephalic-delivered neonates, although the difference may be less significant than previously considered. The majority of the breech-delivered neonates that were initially considered as pathological (Phase 1) are, in fact, healthy. This is ascertained in subsequent ultrasound examinations conducted in later phases (Phases 2-4), when the incidence of pathological cases decreases. This could be attributed to potential different maturation pattern between these groups.

Ultrasonographic screening for developmental dysplasia of the hip: the Graf method revisited.

Until the 1980s, the diagnosis of developmental dysplasia of the hip (DDH) was based on clinical examination and radiographic imaging. In 1980, Reinhard Graf developed his own ultrasonographic method for the examination of the infant hip joint. Graf's method evaluates the osseous and cartilaginous coverage of the femoral head by the acetabulum in the infantile hip joint by measuring the angles α and β. The validity of Graf method is that with these measurements the hip joint is further classified by Graf classification into types I to IV that guide treatment. Currently, Graf method is considered the gold standard examination for the diagnosis of DDH in many European countries. This review article aims to discuss the incidence, risk factors and pathophysiology of DDH, and to emphasize on the Graf method for the evaluation, classification, prevention and further management of this entity.

Evaluation of Interobserver and Intraobserver Differences of Graf Method in Developmental Hip Dysplasia

Evaluation of Interobserver and Intraobserver Differences of Graf Method in Developmental Hip Dysplasia

Segmentation of measurable images from standard plane of Graf hip ultrasonograms based on Mask Region-Based Convolutional Neural Network.

This study proposed a Mask Region-Based Convolutional Neural Network (R-CNN)-based automatic segmentation to accurately detect the measurable standard plane of Graf hip ultrasonography images via segmentation of the labrum, lower limb of ilium, and the iliac wing. The study examined the hip ultrasonograms of 675 infants (205 males, 470 females; mean age: 7±2.8 weeks; range, 3 to 20 weeks) recorded between January 2011 and January 2018. The standard plane newborn hip ultrasound images were classified according to Graf's method by an experienced ultrasonographer. The hips were grouped as type 1, type 2a, type 2b, and type 2c-D. Two hundred seventy-five ultrasonograms were utilized as training data, 30 were validation data, and 370 were test data. The three anatomical regions were simultaneously segmented by Mask-R CNN in the test data and defective ultrasonograms. Automatic instance-based segmentation results were compared with the manual segmentation results of an experienced orthopedic expert. Success rates were calculated using Dice and mean average precision (mAP) metrics. Of these, 447 Graf type 1, 175 type 2a or 2b, 53 type 2c and D ultrasonograms were utilized. Average success rates with respect to hip types in the whole data were 96.95 and 96.96% according to Dice and mAP methods, respectively. Average success rates with respect to anatomical regions were 97.20 and 97.35% according to Dice and mAP methods, respectively. The highest average success rates were for type 1 hips, with 98.46 and 98.73%, and the iliac wing, with 98.25 and 98.86%, according to Dice and mAP methods, respectively. Mask R-CNN is a robust instance-based method in the segmentation of Graf hip ultrasonograms to delineate the standard plane. The proposed method revealed high success in each type of hip for each anatomic region.

The Influence of Risk Factors in the Early Detection of Developmental Dysplasia of the Hip in a Country with Limited Material Resources.

Developmental dysplasia of the hip (DDH) is a condition that includes a wide spectrum of anomalies ranging from simple instability with ligamentous hyperlaxity to the complete displacement of the femoral head outside the abnormally developed cotyloid cavity. Early detection and initiation of treatment allow "restitutio ad integrum" healing, which has raised the medical community's interest in early diagnosis. However, in countries with limited material resources, where echographic screening is not performed, efforts are being made to increase the sensitivity of clinical screening. Thus, the concept of "hip at risk" is taking shape worldwide. This is the normal clinical hip, but associated with one or more risk factors. We conducted a retrospective study for the period 2010-2015 with patients who presented in the ambulatory clinic of the St. John Children's Clinical Hospital, Galati. The study included 560 patients, who were all examined clinically and sonographically, according to the Graf method, by a senior orthopedic doctor with competence in hip sonography. The data obtained from the anamnesis, clinical examination, and ultrasound examination were recorded in the DDH file. The goal of the statistical analysis of the group of patients was to find a correlation between DDH and the risk factors used in the clinical detection of this pathology. In the studied group, four risk factors were identified that have an increased association with DDH: female sex, pelvic presentation, limitation of coxo-femoral abduction, and congenital clubfoot; thus, the conclusion of the study is that patients who have at least one of the listed risk factors should be examined sonographically as quickly as possible. The early ultrasound examination will allow the identification of the disease and the initiation of treatment.

Ultrasonography in the evaluation of various factors of developmental dysplasia of the hip in infants: Results from a retrospective study in a large hospital of northwest China

BackgroundThe occurrence and development of developmental dysplasia of the hip (DDH) are related to a variety of factors, which have been reported in the literature, but the literature does not mention factors related to the severity of DDH. The purpose of this study is to analyze the related factors of the occurrence and severity of DDH in combination with the Graf ultrasonic diagnostic classification. MethodsThis study was a monocentric retrospective study describing the factors associated with DDH in a large hospital of northwest China. A total of 3046 infants (6092 hips) within 6 months after birth using the Graf method were admitted to our department between 2014 and 2018. We analyzed data of DDH. After reviewing medical charts and diagnostic examination results, we assessed whether factors such as ethnicity, gender, gestational age, birth weight, diagnosis age, maternal age, mode of delivery, fetal presentation, amniotic fluid volume and birth order, had any effect on development of hip. Result① Analysis showed that DDH mostly occurs in female and left hip joint, related to intrauterine fetal presentation, amniotic fluid volume, gestational age, mode of delivery, prenatal weight, and diagnosis age after birth, and the occurrence of DDH is also related to maternal age (All P＜0.05). Ethnicity and first born showed have no obvious correlation with DDH incidence (p = 0.718, 0.147, respectively). ② The strongest correlation was found with amniotic fluid, followed by birth weight. ③ The severity of DDH was correlated with ethnicity, births, prenatal weight, gestational age, diagnosis age and maternal age (All P＜0.05, respectively). ④ There were significant differences in treatment methods, duration and prognosis among different types of DDH. ConclusionsThe occurrence and development of DDH are related to a variety of factors. Ultrasound examination can provide an early assessment of the hip development status of infants and may play an important role in establishing an early clinical diagnosis treatment and monitoring and prognosis.

Ultrasound techniques for the detection of developmental dysplasia of the hip: a systematic review and meta-analysis.

Developmental dysplasia of the hip (DDH) encompasses a broad spectrum of hip pathologies, including femoral or acetabular dysplasia, hip instability, or both. According to the medical literature, ultrasonography is the most reliable diagnostic method for DDH. Several techniques for the assessment of hips in newborns and infants, using ultrasonography, have been described. To compare the accuracy of the Graf technique and other diagnostic techniques for DDH. A systematic review of studies that analyzed ultrasound techniques for the diagnosis of DDH within an evidence-based health program of a federal university in São Paulo (SP), Brazil. A systematic search of relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, and LILACS databases for articles published up to May 5, 2020, relating to studies evaluating the diagnostic accuracy of different ultrasound techniques for diagnosing DDH. The QUADAS 2 tool was used for methodological quality evaluation. All hips were analyzed using the Graf method as a reference standard. The Morin technique had the highest rate of sensitivity, at 81.12-89.47%. The Suzuki and Stress tests showed 100% specificity. The Harcke technique showed a sensibility of 18.21% and specificity of 99.32%. All the techniques demonstrated at least one rate (sensibility and specificity) lower than 90.00% when compared to the Graf method. The Morin technique, as evaluated in this systematic review, is recommended after the Graf method because it has the highest sensitivity, especially with the three-pattern classification of 89.47%. Identifier: CRD42020189686 at the International Prospective Register of Systematic Reviews (identifier: CRD42020189686).

Re-Evaluation of DDH Risk Factors in Helena Rehabilitation Center-Erbil, Kurdistan Region of Iraq

Purpose: Developmental dysplasia of the hip (DDH) comprises a spectrum of abnormalities from hip instability to frank dislocation, Hip ultrasonography prior to femoral head ossification, is recognized as an early diagnostic tool for DDH. It is safe and non-invasive procedure, keeping those babies less than 6 months of age away from radiation hazard. Subjects and Methods: From august 2021 until august 2022, we investigated 534 babies [1068 hips] by ultrasound depending on Graf method to identify DDH types. All included infants were in between 6 weeks- 6 months of age and referred due to have high risk factors. The data was analyzed by using the SPSS, version 28 and Chi- square test of association was used to compare the proportions. Results: On the bases of examining 534 babies [with high-risk groups] by ultrasound of hip, about 50.94 % of them were shown to have different types of DDH while 48.06% were normal, bilateral cases were &gt; unilateral cases and Lt. hip &gt;Rt. Hip were affected. Significant association was found between DDH family history (86%), breech presentation (52%)and swaddling (12%). Conclusions: It is crucial to establish the principle of selected screening programs for early detection of DDH in our society and to identify the incidence and associated risk factors for DDH in high-risk group babies between the ages of six weeks and six months in Erbil city of Kurdistan region-Iraq.

Pubo-femoral distance in selective ultrasound screening of developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH) incidence is already debated due to different types of screening techniques. Despite of that, timely treatment of this pathology is necessary to reduce complications on the hip joint. A retrospective study has been performed on the incidence of DDH in Marche region (Italy) in 2017. Epidemiological data have been collected and evaluated. 302 ultrasound images stored in the hospital archives were selected to measure pubo-femoral distance (PFD) and bony rim percentage (BRP). PFD and BRP values were compared with α and β angles measured by Graf method. DDH incidence was 12%. Girls were more affected than males (ratio 3:1). Right side was more involved, 20% of patient had familiarity with DDH, 7% were breech babies and 15% suffered from other congenital orthopedic diseases. PFD in pathological hips was 3.21 mm (0.60-7 mm) and 2.47 mm (0.80-5.30 mm) in normal hips (P<0.005). Dispersion of PFD with respect to α and β angles showed that PFD grows with increasing β angle values and decreasing α angles. BRP in pathological hips was 47.29%, while in normal hips was 49.53% (<3 months). BRP was 49.71% in normal hips and 45.83% in pathological ones (>3 months). BRP measurement did not match the expected results, requiring more studies before its adoption in clinical practice. Our study evidenced the DDH incidence in Marche region and helped to validate a new screening technique consisting in measuring of PFD. For a full BRP validation, future studies will still be required.

Four decades of the Graf method in screening for developmental dysplasia of the hip (part I): Rightly the gold standard or of dubious benefit?

The method of infant hip sonography according to Graf is used for general hip screening in Serbia, Austria, and Germany and is considered the gold standard. In other countries, such as the USA, however, it is not well accepted and is claimed to lead to high costs and overtreatment. The aim of this study was to investigate how many of the mentioned sources in a recent review article contained sonograms that met the quality criteria as taught in Graf's ultrasound courses. A systematic review published by Sakkers et al. was analyzed in terms of addressing the quality criteria of Graf's method. Studies that were suitable by title, abstract, manuscript, that contained an image of sonographic hip examination, and that were accessible were included into analysis. Within the described review, there were 22 papers on the Graf method. Of these, 10 contained hip sonograms and were applicable for final analysis. The quality criteria according to Graf were not fulfilled within 5 of these 10 papers. Within these papers, there are examples of schematic sonograms that do not correspond with the quality criteria either. Skepticism regarding the Graf method may be based on user errors and insufficient application of the Graf quality assessment algorithm, which results in high intra- and inter-observer variations. Based on these findings, a working group was initiated to evaluate further work according to the same procedure (currently approximately 130 papers).

The evaluation of ultrasonographic hip measurement differences among physicians according to the Graf method in newborns

Background/Aim: Hip ultrasonography (USG) is the most important diagnostic method in developmental hip dysplasia in newborns. However, a disadvantage of the ultrasonography method is that there can be measurement differences among doctors measuring the same hip. We aimed to investigate the causes and solutions of this situation. We further strived to measure the hip ultrasonography performed by different physicians using the Graf method and comparing the obtained values.&#x0D; Methods: Hip USGs of newborns admitted to Malatya Turgut Ozal University Faculty of Medicine Hospital between Jan. 8, 2020 and Jan. 5,.2021 were measured and classified using the Graf method. The study type is consistent with retrospective cohort studies. Newborns aged 0-22 weeks without any additional pathology were included in the study. A radiologist and two orthopedists measured and interpreted the images separately in accordance with the Graf method. The first hip measurements (R1) were made by the radiologist (R) with the USG device, and they were classified according to alpha and beta angles; two printouts were made. The first orthopedic specialist (OS1) and the second orthopedic specialist (OS2) made their measurements with printouts. Subsequently, the results from the physicians were compared.&#x0D; Results: A statistically significant difference was found between R1-OS2 (P &lt; 0.001) and OS1-OS2 (P &lt; 0.001) in terms of the Graf classifications. No statistically significant difference was found between R1 and OS1 in terms of the Graf classification (P = 0.562). A statistically significant difference was found between R1-OS2 (P &lt; 0.001) and OS1-OS2 (P = 0.048) angles (alpha and beta) measurements. While R1 and OS1 measurements were compatible with each other, OS2 measurements were found to be inconsistent.&#x0D; Conclusion: We think that there may be differences in angle measurements and the Graf classification among physicians who perform hip ultrasonography in newborns, and the most important way to correct this is through regular participation of physicians in subject-specific trainings.