Fact-sheet: Developmental dysplasia of hip - dislocation


Updated on 02/27/2026 at 9:45 AM

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Definition

Encompasses congenital Hip abnormalities in newborns and infants leading to Hip dislocation or subluxation.
In the absence of screening and early treatment, it is a cause of early Osteoarthritis of the Hip.

Clinical features

Detected by the Barlow maneuver, the Ortolani test, and the Galeazzi sign.
Incidence between 3 and 20/1000 births.
Risk factors:

  • First-degree family history
  • Female sex
  • Neuromuscular disorders, spina bifida
  • Intrauterine constraints: breech presentation, Macrosomia, twin pregnancy, oligohydramnios

Radiography

In infants at 4 months, radiography is indicated only in cases of clinical-ultrasound discordance, and reveals:

  • decentering of the upper femoral epiphyseal nucleus on Ombredanne's construction
  • a blunted acetabular roof
  • insufficient acetabular depth
  • frequent delayed ossification of the femoral epiphyseal nucleus

Subluxating dysplasia is a cause of early Osteoarthritis characterized on coxometry by:
– an HTE angle > 12°,
– a VCE angle < 20°,
– a cervicodiaphyseal angle > 140°,
– in cases of subluxation, disruption of the cervico-obturator arch.

Ultrasound

Reference modality up to 3 months of age:

Graf's lateral coronal view Morphological analysis:

  • Bony modeling (good, insufficient, or poor)
  • Bony rim (angular, slightly rounded, round, becoming flat, or flat)
  • Cartilaginous roof (covering, widened, pushed upward, pushed medially and downward)

Quantitative analysis (subject to interobserver variability). Normal angle values:

  • Alpha angle >= 60°
  • Beta angle <= 55°

Tréguier-Couture lateral coronal view through the pubic ossification center (independent of Hip position), in the dislocatable position.

  • Distance between the epiphyseal nucleus and the pubic point > 6mm
  • Right-left measurement variation > 1.5mm
  • Coverage angle (radio d/D): Normal > 50%

Classification

Graf classification in infants:

  • Type 1: Normal hip
  • Type 2: in the newborn, type 2A = "immaturity", after three months, type 2B = dysplasia
  • Type 2D: "critical hips" close to type 3
  • Type 3. Hip subluxation
  • Type 4. True hip dislocation