COMPARATIVE ANALYSIS OF ULTRASOUND AND RADIOGRAPHIC EVALUATION IN DEVELOPMENTAL DYSPLASIA OF THE HIP IN YOUNG CHILDREN
Keywords:
Key words: developmental dysplasia of the hip, ultrasonography, radiography, Graf method, acetabular index, pediatric orthopedics, comparative imaging, hip maturationAbstract
Abstract: Developmental dysplasia of the hip (DDH) is one of the most common congenital musculoskeletal disorders in infants, with early diagnosis being critical for optimal treatment outcomes. This study provides a comprehensive comparative analysis of ultrasound (US) and radiographic (X-ray) imaging modalities in the evaluation of DDH in children. Ultrasound, primarily using the Graf method, serves as the gold standard for infants under 4-6 months due to its ability to visualize unossified cartilaginous structures and its lack of ionizing radiation [Krauss et al., 2025, p. 2]. Radiography becomes the preferred modality after the appearance of femoral head ossification nuclei, typically between 4-9 months, allowing assessment of acetabular index, Shenton's line integrity, and femoral head position [Alam et al., 2025, p. 3]. Key findings reveal significant discrepancies between the two modalities: while ultrasonographic hip maturation may appear complete, radiographic assessment can demonstrate persistent pathology in 38% of cases [Atalar et al., 2020, p. 228]. The sensitivity of ultrasound compared to radiography as the reference standard is approximately 45.7%, with specificity of 100% [Atalar et al., 2020, p. 229]. Recent advances include AI-assisted automated analysis achieving Graf angle error rates of 0.21 and three-dimensional ultrasound improving inter-observer reliability [Lee et al., 2025, p. 5; Ghasseminia et al., 2021, p. 1458]. This review emphasizes that ultrasound and radiography are complementary rather than interchangeable, with optimal diagnostic accuracy achieved through age-appropriate modality selection and integrated interpretation of both imaging techniques.
References
1. Alam, D., et al. (2025). Radiographic criteria in developmental dysplasia of the hip in late infancy, inter and intrareader agreement. PLoS One, 20(8), e0329230. [p. 2-5]
2. Atalar, H., et al. (2020). Discrepancy between ultrasonographic and radiographic findings in patients treated for developmental dysplasia of the hip; hip maturation on ultrasonography may not be consistent with radiographic hip maturation. Journal of Pediatric Orthopaedics B, 29(3), 228-234. [p. 228-230]
3. Barrera, C. A., et al. (2019). Imaging of developmental dysplasia of the hip: ultrasound, radiography and magnetic resonance imaging. Pediatric Radiology, 49(12), 1652-1668. [p. 1653-1660]
4. Ghasseminia, S., et al. (2021). Narrative Review on the Role of Imaging in DDH. Indian Journal of Orthopaedics, 55(6), 1456-1465. [p. 1456-1462]
5. Krauss, J., et al. (2025). Developmental dysplasia of the hip: ultrasound evaluation. Pediatric Radiology, Online ahead of print. [p. 2-8]
6. Lee, Y. S., et al. (2025). Automated Neonatal Hip Ultrasound System for Diagnosing Developmental Dysplasia of Hips Using Assistive AI. Journal of Imaging Informatics in Medicine, Online ahead of print. [p. 2-5]
7. Sioutis, S., et al. (2025). Impact of probe tilt on Graf ultrasonography accuracy for neonatal hip dysplasia screening. SICOT Journal, 11, 16. [p. 2-4]
8. Vogt, B., et al. (2025). Early Screening for Developmental Dysplasia of the Hip: Sonographic Reference Values, Risk Factors, and Treatment Considerations. International Journal of Neonatal Screening, 11(3), 45. [p. 2-4]
9. Walbron, P., et al. (2019). Bone maturation of MRI residual developmental dysplasia of the hip with discrepancy between osseous and cartilaginous acetabular index. Journal of Pediatric Orthopaedics B, 28(5), 419-423. [p. 420-422]
10. Wuermeling, Q. J., et al. (2025). Ultrasound is a suitable radiation-free alternative for hip surveillance in children with cerebral palsy or developmental dysplasia of the hip older than one year. International Orthopaedics, Online ahead of print. [p. 2-4]
