Modified Center-Edge Angle in Children with Developmental Dysplasia of the Hip

Developmental dysplasia of the hip (DDH) is a prevalent developmental condition that necessitates early detection and treatment. Follow–up, as well as therapeutic decision-making in children younger than four years, is challenging because the center–edge (CE) angle of Wiberg is not reliable in this age group. The authors propose a modification of the CE angle (MCE) to achieve comparable reliability with the CE among children younger than four and set diagnostic thresholds for the diagnosis of DDH. 952 anteroposterior pelvic radiographs were retrospectively reviewed. The MCE is defined on X-ray pelvic overview images as the angle between the line connecting the epiphyseal joint center and the outer edge of the acetabulum, and perpendicular to the Hilgenreiner line. The MCE angle exhibited high sensitivity and specificity, as well as intrarater variability comparable to the CE among children younger and older than four years. The authors recommend cut-off values for the MCE angle; for children under four years old, the angle should be equal to or greater than 15 degrees; for those under eight years old, it should be equal to or greater than 20 degrees; and for those eight years old and older, it should be equal to or greater than 25 degrees. However, the MCE angle’s reliability diminishes around the age of nine due to the curvature of the growth plate, which complicates accurate measurement. This study showed that the MCE angle can be used adequately in children under four years and could be used as a progression parameter to diagnose DDH.