Presenting Author ndash

Dr Sanjay M Khaladkar

Co-Authors ndash

Dr Dhaval K Thakkar

Institution ndash

Dr D Y Patil Medical College

Pimpri Pune

Drawing of the neonatal hip is provided to illustrate anatomical landmarks

Drawings of the neonatal hip are shown above demonstrating graphical overlays of the HIP

ANGLE measurement methods

Normal infant hip ultrasound

bull type I alpha angle gt 60 degrees (normal)bull type Ia beta angle lt 55 degreesbull type Ib beta angle gt 55 degrees

bull type IIbull type IIa alpha angle 50 - 59 degreesbull type IIb alpha angle 50 - 59 degreesbull type IIc

bull alpha angle 43 - 49 degreesbull beta angle lt 77 degrees

bull type D (about to decenter)bull alpha angle 43 - 49 degreesbull beta angle gt 77 degrees

bull type III alpha angle lt 43 degreesbull type IIIa and IIIb distinguished on the

grounds of structural alteration of the cartilaginous roof

bull type IVbull alpha angle lt 43 degreesbull dislocated with labrum interposed

between femoral head and acetabulum

Case 1 Clinical Profile

This was a 10 day old infant not moving the left lower limb with tenderness on left hip movement passively Clinical suspicion

was developmental dysplasia of hip and was referred for a scan

US revealed Alpha angle = 45560 and Beta angle = 52400

Developmental Dysplasia Of Hip (DDH)

Case 2 Clinical Profile

21 yearsfemale came with complaints of left hip pain since childhood which is slowly

increasing in intensity and aggravates during winters Patient is not able to squat for a long

time No ho traumafall No ho feverTB

Hilgenreiners lineHilgenreiners line is drawn horizontally through the superior aspect of both triradiate cartilages It should be horizontal but is mainly used as a reference for Perkins line and measurement of the acetabular angle

Perkins linePerkins line is drawn perpendicular to Hilgenreiners line intersecting the lateral most aspect of the acetabular roof The upper femoral epiphysis should be seen in the inferomedial quadrant (ie below Hilgenreiners line and medial to Perkins line)

Drawing of the neonatal hip is provided to illustrate anatomical landmarks

Drawings of the neonatal hip are shown above demonstrating graphical overlays of the HIP

ANGLE measurement methods

Normal infant hip ultrasound

bull type I alpha angle gt 60 degrees (normal)bull type Ia beta angle lt 55 degreesbull type Ib beta angle gt 55 degrees

bull type IIbull type IIa alpha angle 50 - 59 degreesbull type IIb alpha angle 50 - 59 degreesbull type IIc

bull alpha angle 43 - 49 degreesbull beta angle lt 77 degrees

bull type D (about to decenter)bull alpha angle 43 - 49 degreesbull beta angle gt 77 degrees

bull type III alpha angle lt 43 degreesbull type IIIa and IIIb distinguished on the

grounds of structural alteration of the cartilaginous roof

bull type IVbull alpha angle lt 43 degreesbull dislocated with labrum interposed

between femoral head and acetabulum

Case 1 Clinical Profile

This was a 10 day old infant not moving the left lower limb with tenderness on left hip movement passively Clinical suspicion

was developmental dysplasia of hip and was referred for a scan

US revealed Alpha angle = 45560 and Beta angle = 52400

Developmental Dysplasia Of Hip (DDH)

Case 2 Clinical Profile

21 yearsfemale came with complaints of left hip pain since childhood which is slowly

increasing in intensity and aggravates during winters Patient is not able to squat for a long

time No ho traumafall No ho feverTB

Hilgenreiners lineHilgenreiners line is drawn horizontally through the superior aspect of both triradiate cartilages It should be horizontal but is mainly used as a reference for Perkins line and measurement of the acetabular angle

Perkins linePerkins line is drawn perpendicular to Hilgenreiners line intersecting the lateral most aspect of the acetabular roof The upper femoral epiphysis should be seen in the inferomedial quadrant (ie below Hilgenreiners line and medial to Perkins line)

Normal infant hip ultrasound

bull type I alpha angle gt 60 degrees (normal)bull type Ia beta angle lt 55 degreesbull type Ib beta angle gt 55 degrees

bull type IIbull type IIa alpha angle 50 - 59 degreesbull type IIb alpha angle 50 - 59 degreesbull type IIc

bull alpha angle 43 - 49 degreesbull beta angle lt 77 degrees

bull type D (about to decenter)bull alpha angle 43 - 49 degreesbull beta angle gt 77 degrees

bull type III alpha angle lt 43 degreesbull type IIIa and IIIb distinguished on the

grounds of structural alteration of the cartilaginous roof

bull type IVbull alpha angle lt 43 degreesbull dislocated with labrum interposed

between femoral head and acetabulum

Case 1 Clinical Profile

This was a 10 day old infant not moving the left lower limb with tenderness on left hip movement passively Clinical suspicion

was developmental dysplasia of hip and was referred for a scan

US revealed Alpha angle = 45560 and Beta angle = 52400

Developmental Dysplasia Of Hip (DDH)

Case 2 Clinical Profile

21 yearsfemale came with complaints of left hip pain since childhood which is slowly

increasing in intensity and aggravates during winters Patient is not able to squat for a long

time No ho traumafall No ho feverTB

Hilgenreiners lineHilgenreiners line is drawn horizontally through the superior aspect of both triradiate cartilages It should be horizontal but is mainly used as a reference for Perkins line and measurement of the acetabular angle

Perkins linePerkins line is drawn perpendicular to Hilgenreiners line intersecting the lateral most aspect of the acetabular roof The upper femoral epiphysis should be seen in the inferomedial quadrant (ie below Hilgenreiners line and medial to Perkins line)

Case 1 Clinical Profile

This was a 10 day old infant not moving the left lower limb with tenderness on left hip movement passively Clinical suspicion

was developmental dysplasia of hip and was referred for a scan

US revealed Alpha angle = 45560 and Beta angle = 52400

Developmental Dysplasia Of Hip (DDH)

Case 2 Clinical Profile

21 yearsfemale came with complaints of left hip pain since childhood which is slowly

increasing in intensity and aggravates during winters Patient is not able to squat for a long

time No ho traumafall No ho feverTB

Hilgenreiners lineHilgenreiners line is drawn horizontally through the superior aspect of both triradiate cartilages It should be horizontal but is mainly used as a reference for Perkins line and measurement of the acetabular angle

Perkins linePerkins line is drawn perpendicular to Hilgenreiners line intersecting the lateral most aspect of the acetabular roof The upper femoral epiphysis should be seen in the inferomedial quadrant (ie below Hilgenreiners line and medial to Perkins line)

Developmental Dysplasia Of Hip (DDH)

Case 2 Clinical Profile

21 yearsfemale came with complaints of left hip pain since childhood which is slowly

increasing in intensity and aggravates during winters Patient is not able to squat for a long

time No ho traumafall No ho feverTB

Hilgenreiners lineHilgenreiners line is drawn horizontally through the superior aspect of both triradiate cartilages It should be horizontal but is mainly used as a reference for Perkins line and measurement of the acetabular angle

Perkins linePerkins line is drawn perpendicular to Hilgenreiners line intersecting the lateral most aspect of the acetabular roof The upper femoral epiphysis should be seen in the inferomedial quadrant (ie below Hilgenreiners line and medial to Perkins line)

Case 2 Clinical Profile

21 yearsfemale came with complaints of left hip pain since childhood which is slowly

increasing in intensity and aggravates during winters Patient is not able to squat for a long

time No ho traumafall No ho feverTB

Hilgenreiners lineHilgenreiners line is drawn horizontally through the superior aspect of both triradiate cartilages It should be horizontal but is mainly used as a reference for Perkins line and measurement of the acetabular angle

Perkins linePerkins line is drawn perpendicular to Hilgenreiners line intersecting the lateral most aspect of the acetabular roof The upper femoral epiphysis should be seen in the inferomedial quadrant (ie below Hilgenreiners line and medial to Perkins line)

Case 2 Clinical Profile

21 yearsfemale came with complaints of left hip pain since childhood which is slowly

increasing in intensity and aggravates during winters Patient is not able to squat for a long

time No ho traumafall No ho feverTB

Acetabular angleThe acetabular angle is formed by the intersection between a line drawn tangential to the acetabular roof and Hilgenreiners line forming an acute angle It should be approximately 30degrees at birth and progressively reduce with maturation of the joint

Case 2 Clinical Profile

21 yearsfemale came with complaints of left hip pain since childhood which is slowly

increasing in intensity and aggravates during winters Patient is not able to squat for a long

time No ho traumafall No ho feverTB

Lateral Center Edge Angle Of Wiberg ndashAngle formed by a line drawn from the centerof the femoral head to the outer edge of theacetabular roof and a verticle line drawnthrough the center of the femoral head

- angle greater than 25 deg are considerednormal

- less than 20 deg indicates severe dysplasia

Developmental Dysplasia Of Hip (DDH)

Coronal and Axial CT Scan Images reveals ndashSubarticular sclerosis subarticular geords shallow acetlabulum malformed femoral head

Definition ndash

Developmental dysplasia of the hip (DDH) results from an abnormal

relationship of the femoral head to the acetabulum It usually occurs from

ligamentous laxity and or abnormal position in utero

Incidence = 15 and 20 per 1000 births

with the majority (60-80) of abnormal hips resolving spontaneously within

2-8 weeks (so called immature hip)

Developmental Dysplasia Of Hip (DDH)

Definition ndash

Developmental dysplasia of the hip (DDH) results from an abnormal

relationship of the femoral head to the acetabulum It usually occurs from

ligamentous laxity and or abnormal position in utero

Incidence = 15 and 20 per 1000 births

with the majority (60-80) of abnormal hips resolving spontaneously within

2-8 weeks (so called immature hip)

Developmental Dysplasia Of Hip (DDH)

Incidence

Secondary Hip Dysplasia

Treatment and prognosis

bull Pavlik harness - usually for younger

patients (lt 6 months of age)

bull closed reduction - usually for older

patients

bull open reduction - much older

patient or if closed reduction not

successful

Application

1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch

Orthop Trauma Surg 198097 (2) 117-33

2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer

Verlag (2006) ISBN3540309578

3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip

Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902

4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia

of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)

854-860

5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of

the newborn Elsevier Health Sciences 2005

REFERENCES

Developmental Dysplasia Of Hip (DDH)

Developmental Dysplasia Of Hip (DDH)

Coronal and Axial CT Scan Images reveals ndashSubarticular sclerosis subarticular geords shallow acetlabulum malformed femoral head

Definition ndash

Developmental dysplasia of the hip (DDH) results from an abnormal

relationship of the femoral head to the acetabulum It usually occurs from

ligamentous laxity and or abnormal position in utero

Incidence = 15 and 20 per 1000 births

with the majority (60-80) of abnormal hips resolving spontaneously within

2-8 weeks (so called immature hip)

Developmental Dysplasia Of Hip (DDH)

Definition ndash

Developmental dysplasia of the hip (DDH) results from an abnormal

relationship of the femoral head to the acetabulum It usually occurs from

ligamentous laxity and or abnormal position in utero

Incidence = 15 and 20 per 1000 births

with the majority (60-80) of abnormal hips resolving spontaneously within

2-8 weeks (so called immature hip)

Developmental Dysplasia Of Hip (DDH)

Incidence

Secondary Hip Dysplasia

Treatment and prognosis

bull Pavlik harness - usually for younger

patients (lt 6 months of age)

bull closed reduction - usually for older

patients

bull open reduction - much older

patient or if closed reduction not

successful

Application

1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch

Orthop Trauma Surg 198097 (2) 117-33

2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer

Verlag (2006) ISBN3540309578

3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip

Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902

4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia

of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)

854-860

5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of

the newborn Elsevier Health Sciences 2005

REFERENCES

Developmental Dysplasia Of Hip (DDH)

Definition ndash

Developmental dysplasia of the hip (DDH) results from an abnormal

relationship of the femoral head to the acetabulum It usually occurs from

ligamentous laxity and or abnormal position in utero

Incidence = 15 and 20 per 1000 births

with the majority (60-80) of abnormal hips resolving spontaneously within

2-8 weeks (so called immature hip)

Developmental Dysplasia Of Hip (DDH)

Definition ndash

Developmental dysplasia of the hip (DDH) results from an abnormal

relationship of the femoral head to the acetabulum It usually occurs from

ligamentous laxity and or abnormal position in utero

Incidence = 15 and 20 per 1000 births

with the majority (60-80) of abnormal hips resolving spontaneously within

2-8 weeks (so called immature hip)

Developmental Dysplasia Of Hip (DDH)

Incidence

Secondary Hip Dysplasia

Treatment and prognosis

bull Pavlik harness - usually for younger

patients (lt 6 months of age)

bull closed reduction - usually for older

patients

bull open reduction - much older

patient or if closed reduction not

successful

Application

1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch

Orthop Trauma Surg 198097 (2) 117-33

2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer

Verlag (2006) ISBN3540309578

3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip

Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902

4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia

of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)

854-860

5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of

the newborn Elsevier Health Sciences 2005

REFERENCES

Developmental Dysplasia Of Hip (DDH)

Definition ndash

Developmental dysplasia of the hip (DDH) results from an abnormal

relationship of the femoral head to the acetabulum It usually occurs from

ligamentous laxity and or abnormal position in utero

Incidence = 15 and 20 per 1000 births

with the majority (60-80) of abnormal hips resolving spontaneously within

2-8 weeks (so called immature hip)

Developmental Dysplasia Of Hip (DDH)

Incidence

Secondary Hip Dysplasia

Treatment and prognosis

bull Pavlik harness - usually for younger

patients (lt 6 months of age)

bull closed reduction - usually for older

patients

bull open reduction - much older

patient or if closed reduction not

successful

Application

1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch

Orthop Trauma Surg 198097 (2) 117-33

2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer

Verlag (2006) ISBN3540309578

3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip

Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902

4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia

of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)

854-860

5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of

the newborn Elsevier Health Sciences 2005

REFERENCES

Developmental Dysplasia Of Hip (DDH)

Incidence

Secondary Hip Dysplasia

Treatment and prognosis

bull Pavlik harness - usually for younger

patients (lt 6 months of age)

bull closed reduction - usually for older

patients

bull open reduction - much older

patient or if closed reduction not

successful

Application

1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch

Orthop Trauma Surg 198097 (2) 117-33

2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer

Verlag (2006) ISBN3540309578

3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip

Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902

4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia

of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)

854-860

5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of

the newborn Elsevier Health Sciences 2005

REFERENCES

Developmental Dysplasia Of Hip (DDH)

Secondary Hip Dysplasia

Treatment and prognosis

bull Pavlik harness - usually for younger

patients (lt 6 months of age)

bull closed reduction - usually for older

patients

bull open reduction - much older

patient or if closed reduction not

successful

Application

1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch

Orthop Trauma Surg 198097 (2) 117-33

2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer

Verlag (2006) ISBN3540309578

3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip

Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902

4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia

of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)

854-860

5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of

the newborn Elsevier Health Sciences 2005

REFERENCES

Developmental Dysplasia Of Hip (DDH)

Treatment and prognosis

bull Pavlik harness - usually for younger

patients (lt 6 months of age)

bull closed reduction - usually for older

patients

bull open reduction - much older

patient or if closed reduction not

successful

Application

1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch

Orthop Trauma Surg 198097 (2) 117-33

2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer

Verlag (2006) ISBN3540309578

3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip

Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902

4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia

of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)

854-860

5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of

the newborn Elsevier Health Sciences 2005

REFERENCES

Developmental Dysplasia Of Hip (DDH)

1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch

Orthop Trauma Surg 198097 (2) 117-33

2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer

Verlag (2006) ISBN3540309578

3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip

Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902

4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia

of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)

854-860

5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of

the newborn Elsevier Health Sciences 2005

REFERENCES

Developmental Dysplasia Of Hip (DDH)