eMedicine Specialties > Radiology > Pediatrics

Developmental Dysplasia of the Hip: Multimedia

Author: Karen I Norton, MD, Professorial Lecturer, Mount Sinai School of Medicine; Director, Pediatric Radiology, Children's Hospital of New Jersey, Newark Beth Israel Medical Center
Coauthor(s): Sandra A Mitre Polin, MD, Assistant Professor of Radiology, Department of Radiology, Abdominal Imaging and Mammography, Georgetown University Hospital
Contributor Information and Disclosures

Updated: Sep 23, 2009

Multimedia

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Media file 1: Frontal radiograph of the pelvis. The ossification centers of the capital femoral epiphyses are symmetric and located in the joint spaces. Both heads project in the inner lower quadrants formed by the intersection of the Hilgenreiner (H) and Perkin (P) lines. Shenton lines (S) are continuous and demarcated by the dashed lines. The acetabular angles are symmetric and less than 28° bilaterally.

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Frontal radiograph of the pelvis. The ossification centers of the capital femoral epiphyses are symmetric and located in the joint spaces. Both heads project in the inner lower quadrants formed by the intersection of the Hilgenreiner (H) and Perkin (P) lines. Shenton lines (S) are continuous and demarcated by the dashed lines. The acetabular angles are symmetric and less than 28° bilaterally.

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Media file 2: Frontal radiograph of the pelvis obtained in an infant before ossification of the capital femoral epiphyses begins. The legs are in the neutral position. The projected location of the unossified femoral heads must be estimated. The right hip is normal. The probable location of the left femoral head projects beyond the joint space and into the lower outer quadrant formed by the intersection of the Hilgenreiner and Perkin lines.

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Frontal radiograph of the pelvis obtained in an infant before ossification of the capital femoral epiphyses begins. The legs are in the neutral position. The projected location of the unossified femoral heads must be estimated. The right hip is normal. The probable location of the left femoral head projects beyond the joint space and into the lower outer quadrant formed by the intersection of the Hilgenreiner and Perkin lines.

(Enlarge Image)

Media file 3: Frontal radiograph of the pelvis in a 1-year-old child with a dislocated right hip. The degree of ossification of the femoral head on the dislocated side is decreased compared with that of the normally located left hip. The abnormally located hip articulates with a false neoacetabulum.

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Frontal radiograph of the pelvis in a 1-year-old child with a dislocated right hip. The degree of ossification of the femoral head on the dislocated side is decreased compared with that of the normally located left hip. The abnormally located hip articulates with a false neoacetabulum.

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Media file 4: Frontal radiograph of the pelvis obtained with the legs in the frog-leg position indicates that the plane of the femoral projection is toward the triradiate cartilage, suggesting that the hips are reducible.

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Frontal radiograph of the pelvis obtained with the legs in the frog-leg position indicates that the plane of the femoral projection is toward the triradiate cartilage, suggesting that the hips are reducible.

(Enlarge Image)

Media file 5: Schematic drawing of the coronal plane used to assess the hip at ultrasonography. The transducer is placed on the lateral aspect of the thigh.

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Schematic drawing of the coronal plane used to assess the hip at ultrasonography. The transducer is placed on the lateral aspect of the thigh.

(Enlarge Image)

Media file 6: Schematic drawing of the transverse plane of the left hip. The anteroposterior orientation depends on whether the right or left hip is being examined. The transducer is placed in the transverse orientation over the anterior upper thigh.

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Schematic drawing of the transverse plane of the left hip. The anteroposterior orientation depends on whether the right or left hip is being examined. The transducer is placed in the transverse orientation over the anterior upper thigh.

(Enlarge Image)

Media file 7: Calculation of the alpha and beta angles to assess acetabular maturity. A standard coronal image is used.

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Calculation of the alpha and beta angles to assess acetabular maturity. A standard coronal image is used.

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Media file 8: Real-time coronal sonogram of the hip shows calculation of the acetabular alpha angle. An angle of 60° or greater indicates acetabular maturity.

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Real-time coronal sonogram of the hip shows calculation of the acetabular alpha angle. An angle of 60° or greater indicates acetabular maturity.

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Media file 9: Real-time coronal sonogram of the hip with calculation of the d/D ratio. Coverage of 58% or greater is considered normal.

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Real-time coronal sonogram of the hip with calculation of the d/D ratio. Coverage of 58% or greater is considered normal.

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Media file 10: Real-time transverse sonogram of the right hip obtained without stress maneuvering reveals that the cartilaginous femoral head is well centered above the triradiate cartilage between the pubis and ischium. Echoes are present through the interface with the cartilage; this appearance has been likened to that of a lollipop, in which the femoral head is the "candy" and the echoes through the cartilage are the "stick." In a normally stable hip, this appearance should be maintained with stress maneuvering.

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Real-time transverse sonogram of the right hip obtained without stress maneuvering reveals that the cartilaginous femoral head is well centered above the triradiate cartilage between the pubis and ischium. Echoes are present through the interface with the cartilage; this appearance has been likened to that of a lollipop, in which the femoral head is the "candy" and the echoes through the cartilage are the "stick." In a normally stable hip, this appearance should be maintained with stress maneuvering.

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Media file 11: Real-time sonogram of the right hip obtained with stress maneuvering reveals that the femoral head is posteriorly displaced over the ischium.

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Real-time sonogram of the right hip obtained with stress maneuvering reveals that the femoral head is posteriorly displaced over the ischium.

(Enlarge Image)

Media file 12: Coronal real-time sonogram of the hip obtained with stress maneuvering reveals significant lateral motion, which is not out of the plane of the baseline. This was accompanied by posterior motion in the transverse plane.

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Coronal real-time sonogram of the hip obtained with stress maneuvering reveals significant lateral motion, which is not out of the plane of the baseline. This was accompanied by posterior motion in the transverse plane.

(Enlarge Image)

Media file 13: Coronal real-time sonogram of the hip obtained with stress maneuvering reveals that the capital femoral epiphysis displaces out of the plane of the baseline. This dislocatable hip was reimaged after Ortolani maneuvering, and the dislocation was reducible.

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Coronal real-time sonogram of the hip obtained with stress maneuvering reveals that the capital femoral epiphysis displaces out of the plane of the baseline. This dislocatable hip was reimaged after Ortolani maneuvering, and the dislocation was reducible.

More on Developmental Dysplasia of the Hip

Overview: Developmental Dysplasia of the Hip

Imaging: Developmental Dysplasia of the Hip

Follow-up: Developmental Dysplasia of the Hip

Multimedia: Developmental Dysplasia of the Hip

References

Clinical practice guideline: early detection of developmental dysplasia of the hip. Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the Hip. American Academy of Pediatrics. Pediatrics. Apr 2000;105(4 Pt 1):896-905. [Medline].
Sankar WN, Weiss J, Skaggs DL. Orthopaedic conditions in the newborn. J Am Acad Orthop Surg. Feb 2009;17(2):112-22. [Medline].
Karmazyn BK, Gunderman RB, Coley BD, Blatt ER, Bulas D, Fordham L, et al. ACR Appropriateness Criteria on developmental dysplasia of the hip--child. J Am Coll Radiol. Aug 2009;6(8):551-7. [Medline].
Krych AJ, Howard JL, Trousdale RT, Cabanela ME, Berry DJ. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia. J Bone Joint Surg Am. Sep 2009;91(9):2213-21. [Medline].
Mahan ST, Katz JN, Kim YJ. To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Joint Surg Am. Jul 2009;91(7):1705-19. [Medline].
Graf R. Guide to Sonography of the Infant Hip. New York, NY: Thieme Medical; 1987.
McMillan JA, DeAngelis CD, Warshaw JB, et al, eds. Oski's Pediatrics: Principles and Practice. 3^rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999.
Koureas G, Wicart P, Seringe R. Etiology of developmental hip dysplasia or dislocation: review article. Hip Int. 2007;17 Suppl 5:1-7. [Medline].
Gerscovich EO. Infant hip in developmental dysplasia: facts to consider for a successful diagnostic ultrasound examination. Appl Radiol. 1999;Mar:18-25.
Nelson WE, Behrman RE, Kliegman RM, et al. Nelson Textbook of Pediatrics. 15^th ed. Philadelphia, Pa: WB Saunders; 1996.
Schwend RM, Schoenecker P, Richards BS, Flynn JM, Vitale M. Screening the newborn for developmental dysplasia of the hip: now what do we do?. J Pediatr Orthop. Sep 2007;27(6):607-10. [Medline].
Hennrikus WL. Developmental dysplasia of the hip: diagnosis and treatment in children younger than 6 months. Pediatr Ann. Dec 1999;28(12):740-6. [Medline].
Fujii M, Nakashima Y, Jingushi S, Yamamoto T, Noguchi Y, Suenaga E, et al. Intraarticular findings in symptomatic developmental dysplasia of the hip. J Pediatr Orthop. Jan-Feb 2009;29(1):9-13. [Medline].
American College of Radiology. ACR Standards, 1999-2000: American College of Radiology Standard for the Performance of the Ultrasound Examination for Detection of Developmental Dysplasia of the Hip. American College of Radiology. Available at http://www.acr.org/cgi-bin/fr?tmpl:standards00,pdf:pdf/hip_dysplasia.pdf. Accessed March 5, 2001.
Graf R. [The use of ultrasonography in developmental dysplasia of the hip.]. Acta Orthop Traumatol Turc. 2007;41 Suppl 1:6-13. [Medline].
Peled E, Eidelman M, Katzman A, Bialik V. Neonatal incidence of hip dysplasia: ten years of experience. Clin Orthop Relat Res. Apr 2008;466(4):771-5. [Medline].
Morin C, Harcke HT, MacEwen GD. The infant hip: real-time US assessment of acetabular development. Radiology. Dec 1985;157(3):673-7. [Medline].
Dezateux C, Rosendahl K. Developmental dysplasia of the hip. Lancet. May 5 2007;369(9572):1541-52. [Medline].
Kirks DR, Griscom NT. Practical Pediatric Imaging Diagnostic Radiology of Infants and Children. Philadelphia, Pa: Lippincott-Raven; 1998.
Ozonoff MB. Pediatric Orthopedic Radiology. 2^nd ed. Philadelphia, Pa: WB Saunders; 1992.
Wientroub S, Grill F. Ultrasonography in developmental dysplasia of the hip. J Bone Joint Surg Am. Jul 2000;82-A(7):1004-18. [Medline].
Tudor A, Sestan B, Rakovac I, Luke-Vrbanic TS, Prpic T, Rubinic D, et al. The rational strategies for detecting developmental dysplasia of the hip at the age of 4-6 months old infants: a prospective study. Coll Antropol. Jun 2007;31(2):475-81. [Medline].
AIUM practice guideline for the performance of an ultrasound examination for detection and assessment of developmental dysplasia of the hip. J Ultrasound Med. Jan 2009;28(1):114-9. [Medline].
Kotnis R, Spiteri V, Little C, Theologis T, Wainwright A, Benson MK. Hip arthrography in the assessment of children with developmental dysplasia of the hip and Perthes' disease. J Pediatr Orthop B. May 2008;17(3):114-119. [Medline].
Janssen D, Kalchschmidt K, Katthagen BD. Triple pelvic osteotomy as treatment for osteoarthritis secondary to developmental dysplasia of the hip. Int Orthop. Feb 12 2009;[Medline].

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Keywords

developmental dysplasia of the hip, DDH, congenital dislocation of the hips, CDH, acetabulum, femoral head, proximal femur, acetabular disorder, myelodysplasia, arthrogryposis

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Contributor Information and Disclosures

Author

Karen I Norton, MD, Professorial Lecturer, Mount Sinai School of Medicine; Director, Pediatric Radiology, Children's Hospital of New Jersey, Newark Beth Israel Medical Center
Karen I Norton, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Radiological Society of North America, and Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Coauthor(s)

Sandra A Mitre Polin, MD, Assistant Professor of Radiology, Department of Radiology, Abdominal Imaging and Mammography, Georgetown University Hospital
Sandra A Mitre Polin, MD is a member of the following medical societies: American College of Radiology, Association of University Radiologists, Radiological Society of North America, and Society of Radiologists in Ultrasound
Disclosure: Nothing to disclose.

Medical Editor

Henrique M Lederman, MD, PhD, Consulting Staff, Department of Radiology, LeBonheur Children's Medical Center and St Jude Children's Research Hospital; Professor of Radiology and Pediatric Radiology, Chief, Division of Diagnostic Imaging in Pediatrics, Federal University of Sao Paulo, Brazil
Henrique M Lederman, MD, PhD is a member of the following medical societies: Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

John Karani, MBBS, FRCR, Clinical Director of Radiology and Consultant Radiologist, Department of Radiology, King's College Hospital, London
John Karani, MBBS, FRCR is a member of the following medical societies: British Institute of Radiology, British Society of Interventional Radiology, Cardiovascular and Interventional Radiological Society of Europe, European Society of Gastrointestinal and Abdominal Radiology, European Society of Radiology, Radiological Society of North America, and Royal College of Radiologists
Disclosure: Nothing to disclose.

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eMedicine Specialties > Radiology > Pediatrics

Developmental Dysplasia of the Hip: Multimedia

Multimedia

Frontal radiograph of the pelvis in a 1-year-old child with a dislocated right hip. The degree of ossification of the femoral head on the dislocated side is decreased compared with that of the normally located left hip. The abnormally located hip articulates with a false neoacetabulum.

Frontal radiograph of the pelvis obtained with the legs in the frog-leg position indicates that the plane of the femoral projection is toward the triradiate cartilage, suggesting that the hips are reducible.

Schematic drawing of the coronal plane used to assess the hip at ultrasonography. The transducer is placed on the lateral aspect of the thigh.

Schematic drawing of the transverse plane of the left hip. The anteroposterior orientation depends on whether the right or left hip is being examined. The transducer is placed in the transverse orientation over the anterior upper thigh.

Calculation of the alpha and beta angles to assess acetabular maturity. A standard coronal image is used.

Real-time coronal sonogram of the hip shows calculation of the acetabular alpha angle. An angle of 60° or greater indicates acetabular maturity.

Real-time coronal sonogram of the hip with calculation of the d/D ratio. Coverage of 58% or greater is considered normal.

Real-time sonogram of the right hip obtained with stress maneuvering reveals that the femoral head is posteriorly displaced over the ischium.

Coronal real-time sonogram of the hip obtained with stress maneuvering reveals significant lateral motion, which is not out of the plane of the baseline. This was accompanied by posterior motion in the transverse plane.

Coronal real-time sonogram of the hip obtained with stress maneuvering reveals that the capital femoral epiphysis displaces out of the plane of the baseline. This dislocatable hip was reimaged after Ortolani maneuvering, and the dislocation was reducible.

More on Developmental Dysplasia of the Hip

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

CME Editor

Chief Editor