The Risk of Developmental Dysplasia of the Hip (DDH) in High Birth Weight babies: A Major Risk Factor Detected in the Analyses of Sonograms based on the Graf Technique

Background: The purpose of this retrospective study was to check sonographic hip types according to the Graf technique and to compare the results related to large newborns with those related to the normal and small ones based on their Gestational Age (GA); and to investigate the influence of birth weight on the incidence of Developmental Dysplasia of the Hip (DDH). Methods: Between 1993 and 2003 Ultrasonography (US) of the hips was performed in 7417 consecutive newborns at 34-42 gestational weeks using the Graf method during the first week of life. Results: The US showed pathological findings in 168 hips (2.3%). 139 of these cases were girls (82.7%) and 29 were boys (17.3%). According to Graf types, there were 63 type IIc, 56 type D, 46 type III, and 3 type IV hips. Except for one boy (type III) all were successfully treated by conservative orthopedic methods. Being overweight (large for GA) in association with breech presentation showed the highest risk for pathological hips requiring treatment (15.6%), followed by normal weight and breech presentation (7.6%), and then came the term newborns large for GA (5%). The lowest percentage need of subsequent orthopedic treatment was in 66 in small newborns for GA with breech presentation (1.5%). There were no associations with DDH in 230 small GA newborns at term, and in 174 twins. Conclusion: The results, according to the sonographic types, suggest that high birth weight is a major risk factor of DDH, especially when combined with breech presentation; and an almost 5:1 female preponderance was observed

Diagnosing developmental dysplasia of the hip using the Graf ultrasound method: risk and protective factor analysis in 11,820 universally screened newborns

The essential role of ultrasound examinations in diagnosis and treatment of developmental dysplasia of the hip (DDH) is widely accepted while the weighting and correlation of protective factors and perinatal risk for DDH still give rise to debate. Our aim was to investigate the impact of single and twofold combined risk and protective factors on the newborns' hip maturity, assessed with the Graf ultrasound method. Therefore, data sets of 11,820 universally screened newborns were analyzed. Univariate and logistic regression analyses were performed to correlate risk and protective factors with mature or immature but appropriate for age and pathologic hip types. Thereby, female gender (OR 4.07 (95% CI 3.01–5.51), p < 0.001), breech presentation (4.98 (3.71–6.71), p < 0.001), and positive family anamnesis (5.05 (3.49–7.31), p < 0.001) as well as the combination of female gender with high birth weight (3.51 (2.45–5.03), p < 0.001) could be identified as independent predictive risk factors. Only low birth weight (0.27 (0.11–0.66), p = 0.004) could be identified as a single protective factor, while no combination of protective factors was significant. Conclusion: The significance and the informative value of risk and protective factor combinations, e.g., for selective ultrasound surveys, are limited. Early universal ultrasound screening using the Graf method is advised to timely detect hip immaturity and pathologies and to provide the optimal approach for mature or immature but appropriate for age and pathologic hips