Study of Developmental Hip Dysplasia in Saudi Infants Using Ultrasonography

Abstract

The objectives of this study were to characterize the DDH in Saudi infants using US, also to evaluate the hip joint for infants who were clinically diagnosed to have Developmental hip dysplasia (DDH) focusing mostly on the Graf’s method using ultrasonography, by measuring the α and β angles and correlate the results with the anatomical findings related the hip. The study was conducted during the period extended from 2011 up to 2017. The hips of 536 newborn infants were examined by US using routines screening program for DDH at age 1 day up to 4 months. Ultrasonographic examination was performed with a 12-7.5,3.5, 5 MHZ, linear transducer (Toshiba, Philips 2010, volusum4000, Son layer SSA-270A, Japan). The sample including 145 (27.1%) females and 391(72.9%) males. Participant's age were <30 days were 506(94.4%),31-60 days were 9(1.7%),61-90 days were 11(2.1%) ,and ages between 91-120 days were 10(1.9%). The most common affected age were ages<30 days, 280 were of type1, 9 were 2a < 3m, 75 were 2b >3m and 29 were 2c. 44 were type 3 and 30 were type 4 with significant relation with age at p<0.018, 0.000, 0.005 for type 1, 2, and 4 respectively .There is significant relation between type 2 and 3 dislocation and the risk factor. When characterizing hip joint and its development in different types of DDH, results showed that the acetabulum is well developed in type 1 and least developed in type 3 and 4 significantly at p <0.002, 0.000,0.000 the femoral head is outside the acetabuler cavity in both type 3 and 4 while it was found inside the groove in type 1 .The ischium was found to be well developed in type1 while in type 3and4 most of the cases were not developed .Normal Illiac line capsule, acetabular cartilage, Femoral head ligament were detected in type 1 where significant changes were detected in type 3 and 4. Results revealed that there was significant association between the β angle and acetabulum development, V normality of the acetabuler labrum and normal presence of femoral head within the acetabuler cavity, at p <0.000,0.000,0.000 however the α angle should be considered if there is abnormal presentation of the labrum . Ischia development and acetabular bony roof rim , joint capsule , acetabular hyaline cartilage and femoral head ligament normality were well correlated with the β angle at p<0.006 and 0.000 this revealed that it was better to measure the α and β angle than to define the hip morphology and pathology alone .