Sonographic Hip Angles in Relation to Gestational Age of Neonates. A Prospective, Cohort in the Population of Northern Greece

Document Type : RESEARCH PAPER


1 2ndOrthopaedic Department, “Papageorgiou” General Hospital of Thessaloniki, Thessaloniki, Greece

2 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, “Papageorgiou” General Hospital of Thessaloniki, Thessaloniki, Greece


Background: Developmental dysplasia of the hip (DDH) is a condition with variation among ethnicities and regions. We aimed to investigate the effect of a gestational week of birth on the sonographic acetabular hip angles of newborns. Methods: We prospectively scanned the hips of neonates born in a single, tertiary hospital during their first week of life, using the Graf sonographic method. Demographics, obstetric history of the mother, birth weight, parity, presentation, family history of developmental dysplasia of the hip (DDH), gender, mode of delivery, single/multiple birth, and gestational age were recorded. Acetabular α and β angles were measured, and hip type was determined according to Graf’s classification. Patients were divided according to the gestational age of birth (<37 weeks, 37-38, 38-39, 39-40, >40 weeks). Results: From May- October 2020, 342 babies (684 hips) were examined (52.9% males / 47.1% females). 76.7% were Caucasian-Greek, and 88.3% were term babies. There was a significant difference between the α-angles of the right and left hip in both genders. More females had Type II hips than males. Subgroup analysis did not reveal a significant difference in hip angles of term babies. There was no correlation between birth weight or gestational age and hip angles. Female gender and the existence of maternal thyroidopathy were positively correlated with Type II hips. Conclusion: Gestational birth age in term infants is unimportant regarding acetabular hip angles. Female gender and maternal thyroidopathy appeared to be related to hip type. Further investigation may be warranted to elucidate the effect of maternal thyroidopathy and hip development. Level of evidence: II


Main Subjects

  1. Harcke HT. Developmental Dysplasia of the Hip: A Spectrum of Abnormality. Pediatrics. 1999;103(1):152-153. doi:10.1542/peds.103.1.152
  2. Aronsson DD, Goldberg MJ, Kling TFJ, Roy DR. Developmental dysplasia of the hip. Pediatrics. 1994;94(2 Pt 1):201-208.
  3. Storer SK, Skaggs DL. Developmental dysplasia of the hip. Am Fam Physician. 2006;74(8):1310-1316.
  4. Barlow TG. Early diagnosis and treatment of congenital dislocation of the hip. J Bone Joint Surg Br. 1962;44-B(2):292-301. doi:10.1302/0301-620X.44B2.292
  5. Tan SH, Wong KL, Lim AK, Hui JH. The earliest timing of ultrasound in screening for developmental dysplasia of the Ultrasonography. 2019;38(4):321-326. doi:10.14366/usg.18075
  6. Gokharman FD, Aydin S, Fatihoglu E, Ergun E, Kosar PN. Optimizing the time for developmental dysplasia of the hip screening: earlier or later? Ultrasound Q. 2019;35(2):130-135. doi: 10.1097/RUQ.0000000000000348.
  7. Lussier EC, Sun YT, Chen HW, Chang TY, Chang CH. Ultrasound screening for developmental dysplasia of the hip after 4 weeks increases exam accuracy and decreases follow-up visits. Pediatr Neonatol. 2019;60(3):270-277. doi: 10.1016/j.pedneo.2018.07.008.
  8. Lee J, Spinazzola RM, Kohn N, Perrin M, Milanaik RL. Sonographic screening for developmental dysplasia of the hip in preterm breech infants: do current guidelines address the specific needs of premature infants? J Perinatol. 2016;36(7):552-556. doi:10.1038/jp.2016.7
  9. Jeon GW, Choo HJ, Kwon YU. Risk factors and screening timing for developmental dysplasia of the hip in preterm infants. Clin Exp Pediatr. 2022;65(5):262-268.. doi:10.3345/cep.2021.01074
  10. Mahan ST, Katz JN, Kim Y-J. To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Jt Surgery Am. 2009;91(7):1705. doi: 10.2106/JBJS.H.00122.
  11. Myers J, Hadlow S, Lynskey T. The effectiveness of a programme for neonatal hip screening over a period of 40 years: a follow-up of the New Plymouth experience. J Bone Joint Surg Br. 2009;91(2):245-248. doi: 10.1302/0301-620X.91B2.21300.
  12. Thaler M, Biedermann R, Lair J, Krismer M, Landauer F. Cost-effectiveness of universal ultrasound screening compared with clinical examination alone in the diagnosis and treatment of neonatal hip dysplasia in Austria. J Bone Joint Surg Br. 2011;93(8):1126-1130. doi: 10.1302/0301-620X.93B8.25935.
  13. Holen KJ, Tegnander A, Bredland T, et al. Universal or selective screening of the neonatal hip using ultrasound? A prospective, randomised trial of 15 529 newborn infants. J Bone Joint Surg Br. 2002;84(6):886-890. doi: 10.1302/0301-620x.84b6.12093.
  14. Loder RT, Skopelja EN. The epidemiology and demographics of hip dysplasia. ISRN Orthop. 2011;2011:238607. doi:10.5402/2011/238607
  15. Danielsson LG. Instability of the hip in neonates. An ethnic and geographical study in 24,101 newborn infants in Malmö. J Bone Joint Surg Br. 2000;82(4):545-547. doi:10.1302/0301-620x.82b4.10331
  16. Exner GU. Ultrasound screening for hip dysplasia in neonates. J Pediatr Orthop. 1988;8(6):656-660. doi:10.1097/01241398-198811000-00005
  17. Dogruel H, Atalar HA, Yavuz OY, Sayli U. Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip. Int Orthop. 2008;32(3):415-419. doi:10.1007/s00264-007-0333-x
  18. Giannakopoulou C, Aligizakis A, Korakaki E, et al. Neonatal screening for developmental dysplasia of the hip on the maternity wards in Crete, Greece. correlation to risk factors. Clin Exp Obstet Gynecol. 2002;29(2):148-152.
  19. Ponseti I V. Growth and development of the acetabulum in the normal child. Anatomical, histological, and roentgenographic studies. J Bone Joint Surg Am. 1978;60(5).
  20. Ponseti I V. Morphology of the acetabulum in congenital dislocation of the hip. Gross, histological and roentgenographic studies. J Bone Joint Surg Am. 1978;60(5).
  21. Strayer LMJ. Embryology of he human hip joint. Clin Orthop Relat Res. 1971;74:221-240.
  22. Watanabe RS. Embryology of the Human Hip. Clin Orthop Relat Res. 1974; (98):8-26. doi: 10.1097/00003086-197401000-00003.
  23. Lee J, Jarvis J, Uhthoff HK, Avruch L. The fetal acetabulum. A histomorphometric study of acetabular anteversion and femoral head coverage. Clin Orthop Relat Res. 1992;(281):48-55.
  24. Delaere O, Dhem A. Prenatal development of the human pelvis and acetabulum. Acta Orthop Belg. 1999;65(3):255-260.
  25. Duramaz A, Duramaz BB, Bilgili MG. Does gestational age affect ultrasonographic findings of the hip in preterm newborns? A sonographic study of the early neonatal period. J Pediatr Orthop B. 2019;28(2):107-110. doi:10.1097/BPB.0000000000000541
  26. Uludag S, Seyahi A, Orak MM, Bilgili MG, Colakoglu B, Demirhan M. The effect of gestational age on sonographic screening of the hip in term infants. Bone Joint J. 2013;95-B(2):266-270. doi:10.1302/0301-620X.95B2.30798
  27. Simić S, Vukasinović Z, Samardzić J, et al. Does the gestation age of newborn babies influence the ultrasonic assessment of hip condition? Srp Arh Celok Lek. 2009;137(7-8):402-408. doi:10.2298/sarh0908402s
  28. Graf R. The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound Arch Orthop Trauma Surg (1978). 1980;97(2):117-133. doi:10.1007/BF00450934
  29. Graf R. Sonographie der Säuglingshüfte und therapeutische Konsequenzen: ein Kompendium; 13 Tabellen. Georg Thieme Verlag; 2010.
  30. Geneva World Heal Organ. Born Too Soon: The Global Action Report on Preterm Birth. Available at: pdf;jsessi-onid=C5F8733E6D0AD5F6DC6895C5710A85E2?sequence=1. Accessed, 2012.
  31. Hundt M, Vlemmix F, Bais JM. Risk factors for developmental dysplasia of the hip: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2012;165(1):8-17. doi:
  32. Ortiz-Neira CL, Paolucci EO, Donnon T. A meta-analysis of common risk factors associated with the diagnosis of developmental dysplasia of the hip in newborns. Eur J Radiol. 2012;81(3):e344-e351. doi:
  33. Walker JM, Goldsmith CH. Morphometric study of the fetal development of the human hip joint: significance for congenital hip disease. Yale J Biol Med. 1981;54(6):411-437.
  34. Rális Z, McKibbin B. Changes in shape of the human hip joint during its development and their relation to its stability. J Bone Joint Surg Br. 1973;55(4):780-785.
  35. Masłoń A, Sibiński M, Topol M, Krajewski K, Grzegorzewski A. Development of human hip joint in the second and the third trimester of pregnancy; a cadaveric study. BMC Dev Biol. 2013;13:19. doi:10.1186/1471-213X-13-19
  36. Konijnendijk A, Vrugteveen E, Voorthuis B, Boere-Boonekamp M. Association between timing and duration of breech presentation during pregnancy and developmental dysplasia of the hip: A case-control study. J Child Heal Care. 2021;13674935211042198. doi: 10.1177/13674935211042198.
  37. Stiegler H, Hafner E, Schuchter K, Engel A, Graf R. A sonographic study of perinatal hip development: from 34 weeks of gestation to 6 weeks of age. J Pediatr Orthop B. 2003;12(6):365-368. doi:10.1097/01.bpb.0000084466.28647.0e
  38. Langer R, Kaufmann HJ. Sonography of the hip in underweight premature infants. Klin Padiatr. 1987;199(5):373-375. doi: 10.1055/s-2008-1026823.
  39. Lange AE, Lange J, Ittermann T, et al. Population-based study of the incidence of congenital hip dysplasia in preterm infants from the Survey of Neonates in Pomerania (SNiP). BMC Pediatr. 2017;17(1):78. doi:10.1186/s12887-017-0829-5
  40. Ishikawa N. The relationship between neonatal developmental dysplasia of the hip and maternal J Pediatr Orthop. 2008;28(4):432-434. doi:10.1097/BPO.0b013e318168d167
  41. Su P-Y, Huang K, Hao J-H, et al. Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development: a prospective population-based cohort study in China. J Clin Endocrinol Metab. 2011;96(10):3234-3241. doi:10.1210/jc.2011-0274
  42. Ramezani Tehrani F, Nazarpour S, Behboudi-Gandevani S. Isolated maternal hypothyroxinemia and adverse pregnancy outcomes: A systematic J Gynecol Obstet Hum Reprod. 2021;50(7):102057. doi:10.1016/j.jogoh.2020.102057