Pediatric Hip

Protocol
Exam is performed to detect developmental dysplasia of the hip (DDH)
Optimal imaging is obtained between 3 weeks and 6 months of age
Use warm gel and a 7.5 MHz or higher linear transducer
Patient Position
o Supine or lateral decubitus
o Neutral position is with the hip flexed 15-20
o Flexed position is with the hip flexed 90
Sonographer Position
o Use one hand to hold the leg in position and the other to scan

Organ/Or Scan Plane Label Landmarks Identified

der (Identify RT
or LT side)
Hip Coronal For all coronal images:
Gluteus muscles
HIP
Femoral head
CORONAL
Ilium
NEUTRAL
Ischium
POSITON
Triradiate cartilage
Labrum
Same landmarks as above

Measure Alpha Angle and Beta

HIP Angle
CORONAL
NEUTRAL
WITH
MEASUREME
NT

Transverse TX W/O Hip flexed, knee in a neutral

STRESS position

For all transverse images:

Gluteus muscles
Femoral head
Ischium
Labrum
Femoral metaphysis
Femoral shaft
TX W/O Hip flexed, knee rotated away from
STRESS the midline
ABDUCTION
TX WITH With knee rotated outward push
STRESS the knee toward the hip joint -
ABDUCTION Ortolani Test

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 Pediatric Hip
TX W/O Hip flexed, with knee rotated
STRESS toward the midline
ADDUCTION
TX WITH With knee rotated toward the
STRESS midline push knee toward the hip
ADDUCTION joint- Barlow Test

Anatomical/Image Correlation

Normal Measurement Ranges

Structu Area of Plane Measurem Comments

re Interest ent
More widely accepted and used than
Beta angle
Acetabular Smaller the angle the greater the
Roof Line dysplasia
Alpha Angle
Line is drawn parallel to the ossified
Angle >60 is
Denotes the Coronal lateral wall of the ilium
normal
slope of the A second line drawn from the inferior
bony edge of the bony acetabulum, at the
acetabulum triradiate cartilage, to the distal part of
the ilium, tangential to the slope of the
bony acetabulum (roof line)
Angle lies between the proximal end of the
Inclination femur, the medial trochanter and the edge of
Line the acetabulum
Angle Greater the angle, the greater the dysplasia
<55 is Line is drawn parallel to the ossified
Beta Denotes the
Coronal normal
Angle slope of the lateral wall of the ilium
cartilaginous A second line is drawn along the roof
acetabulum of the cartilaginous acetabulum (from
the lateral bony edge of the
acetabulum to the labrum)

Tips
DDH describes a range of hip dysplasias including instability, subluxation and dislocation
Do not perform stress maneuvers on infants in Pavlik harness or splint devices
Associations/ Risk Factors for DDH
o Caucasians
o Females
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 Pediatric Hip
o Breech presentations at birth ( especially Frank breechrump first with legs above
head)
o Oligohydramnios while in utero
o Family history of DDH

Clinical Indications
Instability in the joint
Hip clicks
Limited range of motion of the affected limb
Positive Galeazzi (Allis) test
Abnormal Barlow or Ortolani maneuver
**Only for infants 3 months or older.
Asymmetric skin folds If one knee is lower than the other, there
may be a dislocated hip on the lower side

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