ISSN : 2146-3123
E-ISSN : 2146-3131

Treatment of Graf Type IIa Hip Dysplasia: A Cutoff Value for Decision Making
Fuat Bilgili1, Yavuz Sağlam2, Süleyman Bora Göksan1, Önder Murat Hürmeydan1, Fevzi Birişik1, Mehmet Demirel1
1Department of Orthopedics and Traumatology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
2Department of Orthopedics and Traumatology, Biruni University School of Medicine, İstanbul, Turkey
DOI : 10.4274/balkanmedj.2017.1150

Background: The rate of spontaneous normalization in type IIa hip is reported to be high, whereas in 5-10%, dysplasia persists or worsens. We aimed to evaluate the natural course of type IIa hips by using Graf’s own perspective of physiological immaturity and maturational deficit.
Aims: To evaluate the natural course of type IIa hips by using Graf’s own perspective of physiological immaturity and maturational deficit.
Study Design: A single centre, retrospective cohort study.
Methods: This is an IRB-approved retrospective review of all patients diagnosed with type IIa hip dysplasia at a single institution from 2012 to 2014. All patients included in the study had hip ultrasonography (USG) at two time points; at around six weeks and three months of age. To assess the reliability in alpha (α) and beta (β) angles, USG measurements were carried out on the same image individually by all observers. At the last follow-up, α and β angles were used as the main outcome measurements to evaluate hip maturation. To evaluate the cut-off value of alpha (α) and beta (β) angle for persistent dysplasia, a receiver Operating Characteristics (ROC) diagram was drawn at third month ultrasound.
Results: Sixty-four patients, 88 affected hips (63% unilateral, 37% bilateral) were included.  Mean age at diagnosis was 6.4±2.7 weeks. At initial ultrasonographic evaluation, 54 hips were type IIa(+) (physiological immature) and 34 hips were type IIa(-) (maturational deficit). Improvement to type I was seen in 52 type IIa(+) and 17 type IIa(-) hips. ROC analyses showed that patients do well if the α angle is greater than ° (AUC:0.86; p < 0.001 for the left hip and AUC: 0.72; p=0.008 for the right ). Conclusion: The cut-off value of 55° α angle on initial ultrasound should be taken into account in order to prevent future dysplasia. Alpha angle of less than 55° on initial ultrasound is an independent predictor of sonographic worsening.

Keywords : Alpha angles, beta angles, developmental dysplasia of the hip, graf type 2a, hip ultrasound, maturational deficit, physiological immaturity
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