Adaptation of the Graf hip ultrasound system for a newborn DDH screening program in the humanitarian Swiss Mongolian Pediatric Project (SMOPP)

Purpose: In Mongolia, a developing country in Central Asia, SMOPP has introduced a strategy for early detection and treatment of developmental dysplasia of the hip (DDH). A big screening study with 8356 newborns showed a high incidence of DDH (2%) and a remarkable treatment success with a simple and safe reusable abduction device. In the study, we had employed the gold standard in DDH classification of Graf differing 10 types. Yet, for daily use in our program, it proved to be rather complicated and extensive. Furthermore, different types of dysplasia did not lead to different treatment strategies. In order to simplify the instructions of the screeners and their evaluations, SMOPP developed an adaption of the Graf method.

Method: We adapted the Graf system for use in a DDH screening program in newborns to 4 different types according to the therapeutic consequences: A – none; B – control; C – conservative; D – surgical.

Results: The simplification of the Graf method could quickly be implemented and found high acceptance amongst the performing doctors. It helped to compensate the huge turnover of users in governmental hospitals and it will facilitate the implementation of a nationwide screening program. The selected age group (first days of life) allows a narrowing of treatment strategies, so the adaption does not result in an increase of individual risks. All screening doctors are supervised by experts with profound knowledge of the original Graf method.

Conclusion: The SMOPP adaption of the Graf method is instructed to screeners and shows good acceptance. It will be used in the national newborn DDH screening program in Mongolia.