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Developmental Dysplasia of the Hip — Ultrasound Screening

Hip ultrasound (Graf method) for newborns and infants <6 months old to detect developmental dysplasia of the hip (DDH), enabling early Pavlik harness or abduction brace treatment to prevent late dislocation and avascular necrosis.

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Ortopedi ve Travmatoloji department. Book Appointment →

What is Developmental Dysplasia of the Hip — Ultrasound Screening?

DDH encompasses a spectrum of acetabular dysplasia, hip subluxation, and dislocation, occurring in 1–3 per 1000 live births. Risk factors include breech presentation, female gender (4:1), positive family history, firstborn, oligohydramnios, and conditions of intrauterine packaging (torticollis, metatarsus adductus). Untreated DDH causes long-term gait abnormalities, leg length discrepancy, early osteoarthritis.

Graf ultrasound technique: standardized coronal view of the hip in lateral decubitus position with hip flexed 30° and slightly internally rotated; identifies bony roof, cartilaginous roof, labrum, femoral head; measures alpha angle (acetabular bony roof) and beta angle (cartilaginous roof). Type Ia: alpha >60° (mature normal); Ib: alpha 60° but rounded bony roof; IIa: alpha 50–59°, age <12 weeks (physiologically immature); IIb: same alpha after 12 weeks (dysplastic); IIc: alpha 43–49° (critical dysplasia); D: decentered with normal coverage; III: alpha <43° subluxation; IV: dislocation.

Universal vs. selective screening varies by country: universal newborn ultrasound in Germany and Austria; selective in UK and Türkiye for risk factors (breech, family history) plus all infants with abnormal Ortolani/Barlow maneuvers. Most ultrasound abnormalities resolve spontaneously; intervention threshold is sustained Type IIb or worse.

Symptoms

Asymmetric hip skin folds, gluteal folds, or thigh creases
Limited hip abduction (<60° in 90° flexion)
Positive Ortolani sign (audible/palpable click on abduction with anterior pressure)
Positive Barlow sign (palpable dislocation with adduction and posterior pressure)
Galeazzi/Allis sign (asymmetric knee height in supine flexion) — older infant
Trendelenburg gait, toe-walking, leg-length discrepancy in walking-age children
Most newborns are asymptomatic — universal or risk-based screening is essential

Risk Factors

Breech presentation (especially frank breech)
Female gender (4:1 ratio)
Positive family history (1st-degree relative)
Firstborn child
Oligohydramnios
Tight swaddling (hip extension, adduction)
Associated conditions: torticollis, metatarsus adductus, talipes calcaneovalgus
Genetic syndromes: Larsen, Beals, arthrogryposis

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Newborn with risk factors (breech, family history, female firstborn) — schedule hip ultrasound at 4–6 weeks
  • Asymmetric hip findings on routine examination
  • Positive Ortolani or Barlow maneuver — pediatric orthopedic referral
  • Limited hip abduction in any infant
  • Walking-age child with limp, gait abnormality, or leg-length discrepancy
  • Failed treatment with Pavlik harness or other brace — re-evaluation

Treatment Methods

01
Type I (normal): no treatment, continue routine clinical exams
02
Type IIa (<12 weeks, immature): repeat ultrasound at 6 weeks; most resolve spontaneously
03
Type IIb/IIc (>12 weeks dysplastic): Pavlik harness (full-time wear, hips flexed 90–110°, abduction 30–60°); ultrasound monitoring at 1, 3, 6 weeks; success rate 90–95% in early treatment
04
Type III/IV (subluxation/dislocation): Pavlik harness with close monitoring; if not reduced within 3 weeks, switch to abduction brace (Frejka, Tübingen) or progress to closed reduction with arthrogram and hip spica casting under anesthesia
05
Pavlik harness contraindications: failed reduction after 3 weeks (risk of femoral head AVN with persistent posterior dislocation), Ortolani-irreducible hips, neuromuscular conditions, age >6 months
06
Closed reduction with arthrography and hip spica cast: ages 6–18 months, performed under general anesthesia, cast for 3 months
07
Open reduction (Salter or Pemberton osteotomy ± femoral shortening): age >18 months or failed closed reduction; correct acetabular and femoral abnormalities
08
Late-presenting DDH (walking age): surgical reduction and reconstruction; outcomes worsen with delay
09
Imaging follow-up: ultrasound until age 6 months, then pelvic AP X-ray every 3–6 months until age 2 years, annual thereafter; CT or MRI for surgical planning
10
Long-term surveillance: skeletal maturity follow-up to detect residual acetabular dysplasia, leg-length discrepancy, AVN; periacetabular osteotomy in adolescence/adulthood for residual dysplasia
11
Family education: avoid tight swaddling that extends hips, encourage 'hip-friendly' babywearing with M-position
12
Multidisciplinary team: pediatric orthopedic surgeon, ultrasonographer, pediatrician, physiotherapist, family

Which Department to Visit?

You can visit our Ortopedi ve Travmatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.