Hip ultrasound for babies (Graf method)

Hip ultrasound by the Graf method is the main way to catch hip dysplasia and congenital hip dislocation early. In the first months of life, the head of the thigh bone and the hip socket are still mostly cartilage. X-rays cannot see them. Ultrasound can. The scan does not hurt, uses no radiation and takes 10 to 15 minutes. Newborns can have it from the first days of life if there is a reason. At Oberig Clinic it is done by ultrasound doctors experienced with children, on expert-class machines.

What the scan shows

Hip dysplasia means the socket that should hold the ball of the thigh bone is too shallow. The ball can then slip partly out (subluxation) or fully out (dislocation). In a baby you often cannot see it. Uneven skin folds, legs that do not spread equally or a hip "click" do not always appear, and they sometimes show up in healthy babies too. Ultrasound shows how deep the socket is, the shape of its bony and cartilage parts and where the ball sits.

Dysplasia found in the first weeks is easy to treat with simple tools: a harness or splint that keeps the legs apart while the joint finishes forming. Found late, treatment takes longer and gets harder. Without it, a child may limp, have legs of different lengths and develop early arthritis. That is why at Oberig Clinic an orthopedist checks babies several times from the first month, and every baby in the first month of life gets a hip ultrasound.

What parents notice

See an orthopedist before the planned check if the skin folds on the thighs or bottom are uneven, one leg looks shorter, or the knees sit at different heights when your baby lies on the back with knees bent. Watch out if one thigh spreads out to the side less than the other, or you hear a click. In an older toddler, signs include walking late, limping or a waddling walk.

Dysplasia is more common in girls, first-born babies and on the left side. But any baby can have it. No visible signs does not mean healthy hips. So all babies need a scan in the first months, signs or no signs. That is why the Graf method became the screening standard in many European countries.

Waiting to see if a baby walks normally is not a good plan. By the time a limp shows, the best window for simple treatment has closed. A 15-minute scan at one or two months is far easier on your baby than months in a cast later.

When to do it

The best age for the first scan is 4 to 6 weeks. By then the normal looseness of the ligaments after birth has passed, and the joint is still all cartilage and easy to see. Babies at risk get scanned earlier, in the first days. Risk factors include a breech position in pregnancy, hip problems in parents or siblings, low amniotic fluid, a large baby, foot deformities, a twisted neck (torticollis) and worrying findings at the exam.

The Graf method works well up to about 4 to 6 months. After that, a bone center forms in the ball of the thigh bone and blocks the view, so doctors switch to X-ray. In the first months it is the opposite. X-ray shows little because cartilage is invisible on it, and the baby gets radiation. Ultrasound shows exactly the cartilage, so for young babies it is more accurate and safer.

The Graf method

Austrian orthopedic surgeon Reinhard Graf set a standard view and two angles to measure. The alpha angle shows how deep the bony part of the socket is. The beta angle shows how well the cartilage roof covers the ball. Based on the angles and the socket shape, each hip gets a type:

Graf type	What it means	Next step
Ia, Ib (alpha 60° or more)	mature hip, normal	no treatment
IIa (alpha 50-59°, under 3 months)	normal immaturity	recheck in 4 to 6 weeks
IIb (alpha 50-59°, over 3 months)	delayed maturity	treatment by an orthopedist
IIc (alpha 43-49°)	critical hip	treatment by an orthopedist
D	ball starting to slip off center	treatment by an orthopedist
III, IV	partial or full dislocation	urgent treatment

Each hip is measured on its own, so the report gives a type for the right and the left. The figures are a rough guide. The pediatric orthopedist makes the final call. Accuracy depends on finding the standard view. If the probe sits at the wrong angle, the socket looks deeper or shallower than it is. So the doctor's experience and a calm baby both matter.

Parents sometimes hear different numbers from different scans and worry. Small differences of a few degrees are normal between scans and between doctors. What counts is the type and how it changes over time. If two reports disagree a lot, the orthopedist will usually ask for a repeat scan rather than start treatment on one measurement.

A good report includes images of both hips with the lines and angles drawn in. The orthopedist can check the measurements, and at the next scan compare the two. Keep every report. You will need them at each follow-up visit.

Normal results

Normal is type Ia or Ib. The alpha angle is 60° or more, the bony roof of the socket is well formed and the ball sits in the center. The report may say "type Ia on both sides" or "mature hip joints". Type IIa in a baby under 3 months is not a disease either. It is a stage of growth. The joint is still maturing, so the doctor books a repeat scan to make sure it matures on time.

Warning signs are an alpha angle below 50°, a ball that has shifted, and type IIa that has not become type I by 3 months. The two hips are not always the same. One can be Ia and the other IIa. That is no cause for panic, but it is a reason for a follow-up. Two scans in a row show whether the joint is maturing, and the trend often matters more than one number.

How to prepare and what happens

No special prep is needed. A few tips for a calm visit:

• feed your baby shortly before the scan. Full babies lie more calmly,
• bring a blanket, a diaper, a bottle or pacifier and a favorite rattle,
• dress your baby so the legs and hips are easy to uncover,
• your baby lies on one side in a special cradle. The doctor puts gel on the skin and places the probe over the hip,
• one side is scanned, then the other. The whole scan takes 10 to 15 minutes.

You stay right next to your baby and can hold their hands and talk to them. It does not hurt, but babies sometimes cry just because they are undressed and turned on their side. The doctor will wait until your baby settles. Precise measurements need a still baby. If your baby falls asleep, even better. A sleeping baby is the easiest patient of all. Afterwards, wipe off the gel. No limits. Walk, feed and bathe your baby as usual.

If dysplasia is found

A pediatric orthopedic surgeon prescribes treatment. Most often it is a Pavlik harness or an abduction splint that gently holds the legs bent and apart. In this position the ball sits in the center of the socket, and the joint forms correctly. How long it lasts depends on the type and age, usually from a few weeks to a few months, with follow-up ultrasound.

Wide swaddling alone does not treat dysplasia. Tight swaddling with straight legs actually harms the hips. Massage and exercises help development, but they do not shape the socket. After treatment ends, the orthopedist keeps checking your child at key ages and may order an X-ray around the first birthday. Most children whose dysplasia was found and treated in time grow up with no limits at all.

Common questions

Is it safe for a newborn?

Yes. Ultrasound has no radiation. It can be done from the first days of life and repeated as often as needed. The probe only touches the skin lightly, with no pressure on the joint.

Can an older child have a hip ultrasound?

Yes, but after about six months it is no longer the Graf method. It shows fluid in the joint, for example with transient synovitis after a cold, when a child suddenly starts to limp.

What is a combined pediatric ultrasound?

It combines a brain ultrasound through the soft spot (neurosonography) and a hip scan in one visit. Handy when both are due in the same month, which is common at one month of age. One visit instead of two, and less stress for your baby.

Do I need a referral?

No. You can book yourself. If a pediatrician or orthopedist gave you a referral, bring it, along with the hospital discharge notes that list risk factors.

Can massage replace treatment?

No. Massage and exercises are good for development, but they do not shape the hip socket. Dysplasia needs a device that keeps the ball centered.

When will I get the results?

The doctor explains the result right after the scan, and you get the report with the hip types to take home. Bring it to your orthopedist visit.

Prices

A Graf hip ultrasound costs UAH 1,285. The price is the same at any age, from newborns to toddlers, and there is no extra charge for scanning both hips. If your baby also needs a brain ultrasound, the combined pediatric scan is better value. Some items are for scans by Honored Doctor of Ukraine Nataliia Riepina.

Service	Price
Hip ultrasound, Graf method	UAH 1,285
The same, by Honored Doctor of Ukraine N. Riepina	UAH 1,340
Combined pediatric ultrasound (brain and Graf hips)	UAH 1,395
Combined pediatric ultrasound by N. Riepina	UAH 1,425
Pediatric orthopedic surgeon visit	UAH 1,670

Prices are from the clinic price list as of 01.10.2026 and may change. Please check the current price with our contact center before your visit.

Why choose Oberig Clinic

• Hip screening for babies. An orthopedist checks babies several times from the first month, and every baby in the first month of life gets a hip ultrasound.
• Experienced ultrasound doctors. Children are scanned by Halyna Huivan, a senior-grade ultrasound doctor, and Honored Doctor of Ukraine Nataliia Riepina, an EFSUMB member.
• Pediatric orthopedists on site. They include Professor Anatolii Levytskyi, MD, DSc, so you can discuss the result with an orthopedist right away.
• Everything for your baby in one place. Pediatric ultrasound of any organ, pediatricians, neurologists and a children's ward.

Address: 3 Zoolohichna St, buildings "G" and "V", Kyiv. Book online at https://my.oberig.ua/ua/appointment/ or call +38 044 521 30 03.