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He J, Lyu X, Chen T. Study on the efficacy of brace therapy for developmental dysplasia of the hip with Graf IIc and greater severity. J Pediatr Orthop B 2024; 33:314-321. [PMID: 37548708 DOI: 10.1097/bpb.0000000000001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
To assess changes in the α and β angle with brace treatment in DDH classified as Type Graf IIc, D, III, and IV; to study the α angle threshold that can predict the treatment effect; to analyze the effective rate in different groups. A retrospective study was conducted on children from 2013 to 2018 with Graf type IIc and greater diagnosed with ultrasound (US). Brace therapy was applied to 356 patients, with 423 affected hips (Graf IIc: 202 hips; Graf D: 17 hips; Graf III: 118 hips; and Graf IV: 86 hips). For follow-up efficacy analyses using US, X-ray and clinical examination, based on the success of early treatment of the brace, the outcomes were divided into 'effective' and 'noneffective' groups. The statistical results showed that the α angle increased ( P < 0.05) and the β angle decreased ( P < 0.05). When α≥43°, the accuracy of success with early treatment was 95.95%. The overall effective rate of bracing treatment was 74.70%. Children with α ≥ 43° are recommended to receive brace therapy as soon as possible and demonstrate the best effects. The effective rate varies across different Graf types and the age at treatment initiation. Brace therapy is more effective for Graf IIc and D hips compared to Graf III and IV.
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Affiliation(s)
| | - Xuemin Lyu
- Pediatric Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, The 4th Clinical College, Peking University, Beijing, China
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Nair A, Yatsonsky D, Liu J. Comparison of outcomes of different Graf grades of developmental dysplasia of the hip in infants treated with Tubingen splint versus Pavlik harness - A systematic review. J Orthop 2024; 49:68-74. [PMID: 38075458 PMCID: PMC10701362 DOI: 10.1016/j.jor.2023.11.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 02/29/2024] Open
Abstract
This systematic review was designed to compare the outcomes of the two braces against each other classified by the Graf method. The databases sources included PubMed, Embase, and Google Scholar. The keywords included "DDH Tubingen versus Pavlik" and Tubingen and Pavlik separately. Included papers provided specific data regarding success and failure rate, avascular necrosis (AVN), duration, and age of intervention. The excluded studies discussed surgeries, diagnosis and mechanism, and ones that weren't in English. Total of 20 papers were included, resulting in 1243 Tubingen and 420 Pavlik samples. It was seen that the Tubingen splint had a statistically significant greater success rate and lower failure rate for Graf 2, D, and 3 hips, while both braces were not very successful for Graf 4 at success rates less than 60 %. Tubingen also had a lower incidence of AVN. Both braces shared similar ages of intervention, duration, and time per day. Both braces are very comparable to each other, each having better success rates for lower Graf grades, which points to the importance of bracing earlier to improve the success rates. The Tubingen splint had a higher success rate, lower failure rate, and lower AVN rate compared to the Pavlik harness. This points to the Tubingen splint potentially being the preferred option for bracing in infants.
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Affiliation(s)
- Ajay Nair
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, 43614, United States
| | - David Yatsonsky
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, 43614, United States
| | - Jiayong Liu
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, 43614, United States
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Ucpunar H, Sevencan A, Erbas A, Ozyalvac ON, Akpinar E, Bayhan AI. Effect of the Pavlik harness used in the treatment of developmental dysplasia of the hip on unaided sitting and independent walking age. J Child Orthop 2024; 18:79-84. [PMID: 38348432 PMCID: PMC10859113 DOI: 10.1177/18632521231217330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/11/2023] [Indexed: 02/15/2024] Open
Abstract
Background Pavlik harness is the most widely used orthosis in the treatment of developmental dysplasia of the hip. The aim of this study was to evaluate the effect of the Pavlik harness on the development of "unaided sitting" and "independent walking" in infants with developmental dysplasia of the hip. Methods This prospective study, conducted from 2017 to 2020, included infants undergoing Pavlik harness therapy. Inclusion criteria comprised gestational age > 37 weeks, treatment initiation before 6 months of age, and no prior treatment for developmental dysplasia of the hip. We assessed treatment initiation age, treatment duration, and the age of achieving unaided sitting and independent walking. Results In the patient group, unaided sitting commenced at a mean age of 6.8 ± 1.6 (range: 4-11) months, while independent walking began at a mean age of 12.7 ± 1.8 (range: 9-18) months. By 15 months, 92% of the patients achieved independent walking. In the control group, unaided sitting occurred at a mean age of 6.1 ± 1.1 (range: 4-8) months, and independent walking at 11.8 ± 1.6 (range: 9-18) months. A significant positive correlation was observed between the duration of Pavlik harness usage and the age of unaided sitting (p < 0.001) and independent walking (p < 0.001). Conclusion Our study indicates that Pavlik harness treatment for developmental dysplasia of the hip is generally safe and does not lead to clinically significant delays in unaided sitting and independent walking. However, some minor delays may occur due to extended orthosis use. Level of evidence level III-prospective cohort study.
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Affiliation(s)
- Hanifi Ucpunar
- Department of Orthopaedics Surgery and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Sevencan
- Department of Orthopedics, Medicana Ataköy Hospital, Istanbul, Turkey
| | - Anil Erbas
- Department of Orthopaedics Surgery and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Osman Nuri Ozyalvac
- Department of Orthopaedics Surgery and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Evren Akpinar
- Department of Orthopaedics Surgery and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Avni Ilhan Bayhan
- Department of Orthopaedics Surgery and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
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Dwan K, Kirkham J, Paton RW, Morley E, Newton AW, Perry DC. Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age. Cochrane Database Syst Rev 2022; 10:CD012717. [PMID: 36214650 PMCID: PMC9549867 DOI: 10.1002/14651858.cd012717.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) describes the abnormal development of a hip in childhood, ranging from complete dislocation of the hip joint to subtle immaturity of a hip that is enlocated and stable within the socket. DDH occurs in around 10 per 1000 live births, though only one per 1000 are completely dislocated. There is variation in treatment pathways for DDH, which differs between hospitals and even between clinicians within the same hospital. The variation is related to the severity of dysplasia that is believed to require treatment, and the techniques used to treat dysplasia. OBJECTIVES To determine the effectiveness of splinting and the optimal treatment strategy for the non-operative management of DDH in babies under six months of age. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, seven other electronic databases, and two trials registers up to November 2021. We also checked reference lists, contacted study authors, and handsearched relevant meetings abstracts. SELECTION CRITERIA Randomised controlled trials (RCTs), including quasi-RCTs, as well as non-RCTs and cohort studies conducted after 1980 were included. Participants were babies with all severities of DDH who were under six months of age. Interventions included dynamic splints, static splints or double nappies (diapers), compared to no splinting or delayed splinting. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and performed risk of bias and GRADE assessments. The primary outcomes were: measurement of acetabular index at years one, two and five, as determined by radiographs (angle): the need for operative intervention to achieve reduction and to address dysplasia; and complications. We also investigated other outcomes highlighted by parents as important, including the bond between parent and child and the ability of mothers to breastfeed. MAIN RESULTS We included six RCTs or quasi-RCTs (576 babies). These were supported by 16 non-RCTs (8237 babies). Five studies had non-commercial funding, three studies stated 'no funding' and 14 studies did not state funding source. The RCTs were generally at unclear risk of bias, although we judged three RCTs to be at high risk of bias for incomplete outcome data. The non-RCTs were of moderate and critical risk of bias. We did not undertake meta-analysis due to methodological and clinical differences between studies; instead, we have summarised the results narratively. Dynamic splinting versus delayed or no splinting Four RCTs and nine non-RCTs compared immediate dynamic splinting and delayed dynamic splinting or no splinting. Of the RCTs, two considered stable hips and one considered unstable (dislocatable) hips and one jointly considered unstable and stable hips. No studies considered only dislocated hips. Two RCTs (265 babies, very low-certainty evidence) reported acetabular index at one year amongst stable or dislocatable hips. Both studies found there may be no evidence of a difference in splinting stable hips at first diagnosis compared to a strategy of active surveillance: one reported a mean difference (MD) of 0.10 (95% confidence interval (CI) -0.74 to 0.94), and the other an MD of 0.20 (95% CI -1.65 to 2.05). Two RCTs of stable hips (181 babies, very low-certainty evidence) reported there may be no evidence of a difference between groups for acetabular index at two years: one study reported an MD of -1.90 (95% CI -4.76 to 0.96), and another study reported an MD of -0.10 (95% CI -1.93 to 1.73), but did not take into account hips from the same child. No study reported data at five years. Four RCTs (434 babies, very low-certainty evidence) reported the need for surgical intervention. Three studies reported that no surgical interventions occurred. In the remaining study, two babies in the dynamic splinting group developed instability and were subsequently treated surgically. This study did not explicitly state if this treatment was to achieve concentric reduction or address residual dysplasia. Three RCTs (390 babies, very low-certainty evidence) reported no complications (avascular necrosis and femoral nerve palsy). Dynamic splinting versus static splinting One RCT and five non-RCTs compared dynamic versus static splinting. The RCT (118 hips) reported no occurrences of avascular necrosis (very low-certainty evidence) and did not report radiological outcomes or need for operative intervention. One quasi-RCT compared double nappies versus delayed or no splinting but reported no outcomes of interest. Other comparisons No RCTs compared static splinting versus delayed or no splinting or staged weaning versus immediate removal. AUTHORS' CONCLUSIONS There is a paucity of RCT evidence for splinting for the non-operative management of DDH: we included only six RCTs with 576 babies. Moreover, there was considerable heterogeneity between the studies, precluding meta-analysis. We judged the RCT evidence for all primary outcomes as being of very low certainty, meaning we are very uncertain about the true effects. Results from individual studies provide limited evidence of intervention effects on different severities of DDH. Amongst stable dysplastic hips, there was no evidence to suggest that treatment at any stage expedited the development of the acetabulum. For dislocatable hips, a delay in treatment onset to six weeks does not appear to result in any evidence of a difference in the development of the acetabulum at one year or increased risk of surgery. However, delayed splinting may reduce the number of babies requiring treatment with a harness. No RCTs compared static splinting with delayed or no splinting, staged weaning versus immediate removal or double nappies versus delayed or no splinting. There were few operative interventions or complications amongst the RCTs and the non-randomised studies. There's no apparent signal to indicate a higher frequency of either outcome in either intervention group. Given the frequency of this disease, and the fact that many countries undertake mandatory DDH screening, there is a clear need to develop an evidence-based pathway for treatment. Particular uncertainties requiring future research are the effectiveness of splinting amongst stable dysplastic hips, the optimal timing for the onset of splinting, the optimal type of splint to use and the need for 'weaning of splints'. Only once a robust pathway for treatment is established, can we properly assess the cost-effectiveness of screening interventions for DDH.
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Affiliation(s)
- Kerry Dwan
- Editorial & Methods Department, Cochrane Central Executive, London, UK
| | - Jamie Kirkham
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Robin W Paton
- East Lancashire Hospitals NHS Trust, Burnley, UK
- School of Medicine, University of Central Lancashire, Preston, Lancashire, UK
| | | | | | - Daniel C Perry
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Department of Orthopaedic Surgery, Alder Hey Hospital, Liverpool, UK
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Short Term Results of Early Treatment of Developmental Dysplasia of the Hip or Luxation with Pavlik Harness in Human Position. Medicina (B Aires) 2022; 58:medicina58020206. [PMID: 35208530 PMCID: PMC8874506 DOI: 10.3390/medicina58020206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: This study shows a sufficient treatment with the Pavlik harness for all patients through all phases of developmental dysplasia of the hip (DDH) if there is a strict regime. Materials and Methods: There was an ultrasound measurement stage of IIc or worse (D, IIIa/b, IVa/b) in 159 out of 7372 newborns between 1995 and 2006 (2.15%). This is an indication for treatment with the Pavlik harness. Overall, 203 dysplastic hips were treated initially with our regime. After detection, we started the application of the Pavlik harness immediately in the ‘human position’. There were appointments every 10–14 days to check the setting combined with ultrasound controls. The treatment stopped if a mature, well-developed picture of both hips was seen when compared to Graf type Ia/b. Afterwards, an X-ray control was carried out at about one year of age. Results: 159 newborns with 203 dislocated hips were treated. The distribution following Graf’s classification was as follows: 150 type IIc (73.9%), 18 type D (8.9%), 31 type IIIa/b (15, 3%) and 4 type IV (1.9%). To summarize, there were 150 (73.9%) type IIc hips at risk of developing a dislocation but also 53 hips (26.1%) which were already dislocated at the moment of birth. There was a loss to follow-up in three patients (1.8%), and the therapy had to be changed in six cases. There was no degradation in our study population during therapy. Conclusion: The treatment with the Pavlik harness of DDH at every stage in newborns was possible and showed good results in 189 hips.
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Gou P, Gao K, Wang X, Liu X. The nomogram predicting the early failure rate of the Pavlik harness for developmental dysplasia of the hip in infants under 6 months of age. Front Pediatr 2022; 10:1018641. [PMID: 36263153 PMCID: PMC9574333 DOI: 10.3389/fped.2022.1018641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of our study was to develop a nomogram predicting the early failure rate of Pavlik harness in infants under 6 months of age with developmental dysplasia of the hip (DDH). METHODS We retrospectively analyzed the clinical data of 227 patients (372 hips) with DDH who were treated with Pavlik harness at our institution from August 2019 to January 2022. Fifty-eight patients (102 hips) failed the Pavlik harness treatment, and 169 patients (270 hips) were successfully treated. Then, the independent risk factors for treatment failure were determined via univariate and multivariate logistic regression and used to generate the nomogram predicting the failure rate of the Pavlik harness. RESULTS It was found that age at initial treatment (OR 1.031, 95% CI 1.022-1.040, P < 0.001), angle α (OR 0.723, 95% CI 0.671-0.779, P < 0.001), and concomitant deformity (OR 0.129, 95% CI 0.036-0.459, p = 0.002) were independent risk factors for treatment failure. The nomogram showed good discrimination [the area under the curve (AUC): 0.862], good calibration, and a net benefit in the range of probabilities between 5 and 90% according to the decision curve analysis. CONCLUSION This study successfully established the nomogram prediction model based on three independent risk factors. Due to the high level of predicting accuracy, this nomogram could be a useful resource for pediatric orthopedic surgeons to identify patients at major risk of Pavlik harness failure who might need more reliable treatments.
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Affiliation(s)
- Pan Gou
- Orthopedic Center of Children, Chongqing Medical University, Chongqing, China
| | - Kai Gao
- Orthopedic Center of Children, Chongqing Medical University, Chongqing, China
| | - Xiaoting Wang
- Orthopedic Center of Children, Chongqing Medical University, Chongqing, China
| | - Xing Liu
- Orthopedic Center of Children, Chongqing Medical University, Chongqing, China
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Chaibi E, Saugy CA, Samara E, Zambelli PY, Merckaert SR. Comparison of treatment outcomes of stable and unstable developmental dysplasia of the hip with the Tübingen splint. Front Pediatr 2022; 10:976367. [PMID: 36090577 PMCID: PMC9453388 DOI: 10.3389/fped.2022.976367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Tübingen splint was initially developed for the treatment of stable developmental hip dysplasia (DDH). Later on, some authors expanded its include for the treatment of unstable DDH, but there remain some controversies in the literature. This study aims to compare the outcome between stable and unstable DDH treated with a Tübingen splint. METHODS Epidemiological data and ultrasonographic data of all infants diagnosed with DDH and initially treated with a Tübingen splint at our institution between May 2017 and February 2020 were assessed retrospectively. We divided the population into stable and unstable hips using the Graf classification. Age at treatment initiation, duration of treatment, complications, and radiological outcome between 12 and 24 months were investigated. RESULTS We included a total of 45 patients (57 hips) affected by DDH treated with the Tübingen splint. Treatment has been successful in 93% of stable hips and only 40% of unstable hips. Radiological outcome at 1-year follow-up significantly correlated with initial Graf classification (p < 0.001). CONCLUSION The Tübingen splint is a safe and effective treatment for stable hips, nevertheless, for unstable hips, closed reduction, and spica cast remains the gold standard.
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Affiliation(s)
- Emmelie Chaibi
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Claire-Anne Saugy
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Eleftheria Samara
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pierre-Yves Zambelli
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sophie Rosa Merckaert
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Zhi X, Xiao X, Wan Y, Wei P, Canavese F, Xu H. Tübingen hip flexion splint for the treatment of developmental dysplasia of the hip in children younger than six months age: a meta-analysis. J Child Orthop 2021; 15:402-408. [PMID: 34476031 PMCID: PMC8381402 DOI: 10.1302/1863-2548.15.210015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/17/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate the success rate of the Tübingen hip flexion splint (THFS) for the treatment of developmental dysplasia of the hip (DDH), of different severity as per the Graf classification, among infants younger than six months of age. The type and incidence rate of complications associated with THFS treatment were also evaluated. METHODS The following databases were searched using keywords and limited for age less than six months: PubMed, Embase, Web of Science, Cochrane Library, and SinoMed, between inception and July 2020. Articles were screened and extracted by two researchers, and the quality of the included literature was evaluated (methodological index for non-randomized studies criteria). R studio 1.3 was used for statistical analysis. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS After screening, eight articles were included in the analysis, contributing 1211 hips (875 patients). The overall success rate of THFS treatment is 91% (95% confidence interval (CI) 0.82 to 0.95). The success rate by Graf type is as follows: type-II, 98% (95% CI 0.94 to 1.00); type-III, 96% (95% CI 0.88 to 1.00); and type-IV, 32% (95% CI 0.18 to 0.47). Complications (24/1211, 2%) included transient femoral nerve palsy (n = 1); avascular necrosis of the femoral head (n = 9) and residual acetabular dysplasia (n = 14). CONCLUSION THFS treatment is successful for Graf type-II and -III, but low for type-IV, with a low rate of complication. THFS may be an effective treatment option for DDH among infants less than six months of age. However, those with Graf type-IV require close monitoring. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Xinwang Zhi
- Department of Pediatric Orthopedics, Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Xietian Xiao
- School of Public Health, Guangzhou Medical University, Xinzao, Guangzhou, China
| | - Yuwei Wan
- School of Public Health, Guangzhou Medical University, Xinzao, Guangzhou, China
| | - Ping Wei
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Federico Canavese
- Department of Pediatric Orthopedics, Guangzhou Women and Children’s Medical Center, Guangzhou, China,Department of Pediatric Orthopedic Surgery, Lille University Center and Faculty of Medicine, Lille, France,These authors contributed equally to this work
| | - Hongwen Xu
- Department of Pediatric Orthopedics, Guangzhou Women and Children’s Medical Center, Guangzhou, China,These authors contributed equally to this work,Correspondence Correspondence should be sent to Dr Hongwen Xu, Department of Pediatric Orthopedics, Guangzhou Women and Children’s Medical Center, Guangzhou, 510623 China E-mail:
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Lyu X, Chen T, Yang Z, Fu G, Feng C, Zhang T, Lu M. Tübingen hip flexion splint more successful than Pavlik harness for decentred hips after the age of three months. Bone Joint J 2021; 103-B:991-998. [PMID: 33934653 DOI: 10.1302/0301-620x.103b5.bjj-2020-1946.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The objective of this study was to evaluate the clinical and radiological outcomes of patients younger than six months of age with developmental dysplasia of the hip (DDH) managed by either a Pavlik harness or Tübingen hip flexion splint. METHODS Records of 251 consecutive infants with a mean age of 89 days (SD 47), diagnosed with DDH between January 2015 and December 2018, were retrospectively reviewed. Inclusion criteria for patients with DDH were: younger than 180 days at the time of diagnosis; ultrasound Graf classification of IIc or greater; treatment by Pavlik harness or Tübingen splint; and no prior treatment history. All patients underwent hip ultrasound every seven days during the first three weeks of treatment and subsequently every three to four weeks until completion of treatment. If no signs of improvement were found after three weeks, the Pavlik harness or Tübingen splint was discontinued. Statistical analysis was performed. RESULTS The study included 251 patients with Graf grades IIc to IV in 18 males and 233 females with DDH. Mean follow-up time was 22 months (SD 10). A total of 116 hips were graded as Graf IIc (39.1%), nine as grade D (3.0%), 100 as grade III (33.7%), and 72 as grade IV (24.2%). There were 109 patients (128 hips) in the Pavlik group and 142 patients (169 hips) in the Tübingen group (p = 0.227). The Tübingen group showed a 69.8% success rate in Graf III and Graf IV hips while the success rate was significantly lower in the Pavlik group, 53.9% (p = 0.033). For infants older than three months of age, the Tübingen group showed a 71.4% success rate, and the Pavlik group a 54.4% success rate (p = 0.047). CONCLUSION The Tübingen splint should be the preferred treatment option for children older than three months, and for those with severe forms of DDH such as Graf grade III and IV, who are younger than six months at time of diagnosis. The Tübingen hip flexion splint is a valid alternative to the Pavlik harness for older infants and those with more severe DDH. Cite this article: Bone Joint J 2021;103-B(5):991-998.
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Affiliation(s)
- XueMin Lyu
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
| | - Tao Chen
- Ultrasound Department, Beijing Jishuitan Hospital, Beijing, China
| | - Zheng Yang
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
| | - Gang Fu
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
| | - Chao Feng
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
| | - Tao Zhang
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
| | - Ming Lu
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
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Li H, Shu L, Yu J, Xian Z, Duan H, Shu Q, Ye J. Using Z-score to optimize population-specific DDH screening: a retrospective study in Hangzhou, China. BMC Musculoskelet Disord 2021; 22:344. [PMID: 33845817 PMCID: PMC8042719 DOI: 10.1186/s12891-021-04216-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND DDH (Developmental Dysplasia of the Hip) screening can potentially avert many morbidities and reduce costs. The debate about universal vs. selective DDH ultrasonography screening in different countries revolves to a large extent around effectiveness, cost, and the possibility of overdiagnosis and overtreatment. In this study, we proposed and evaluated a Z-score enhanced Graf method to optimize population-specific DDH screening. METHODS A total of 39,710 history ultrasonography hip examinations were collected to establish a sex, side specific and age-based Z-scores model using the local regression method. The correlation between Z-scores and classic Graf types was analyzed. Four thousand two hundred twenty-nine cases with follow-up ultrasonographic examinations and 5284 cases with follow-up X-ray examinations were used to evaluate the false positive rate of the first examination based on the subsequent examinations. The results using classic Graf types and the Z-score enhanced types were compared. RESULTS The Z-score enhanced Graf types were highly correlated with the classic Graf's classification (R = 0.67, p < 0.001). Using the Z-scores ≥2 as a threshold could reduce by 86.56 and 80.44% the false positives in the left and right hips based on the follow-up ultrasonographic examinations, and reduce by 78.99% false-positive cases based on the follow-up X-ray examinations, respectively. CONCLUSIONS Using an age, sex and side specific Z-scores enhanced Graf's method can better control the false positive rate in DDH screening among different populations.
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Affiliation(s)
- Haomin Li
- Clinical Data Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Binsheng Road 3333#, Hangzhou, 310052, China.
| | - Liqi Shu
- Rhode Island Hospital, Brown University, Providence, USA
| | - Jin Yu
- Department of Ultrasound, The Children's Hospital, Zhejiang University School of Medicine, Binsheng Road 3333#, Hangzhou, 310052, China
| | - Zeng Xian
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Huilong Duan
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Qiang Shu
- Clinical Data Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Binsheng Road 3333#, Hangzhou, 310052, China
| | - Jingjing Ye
- Department of Ultrasound, The Children's Hospital, Zhejiang University School of Medicine, Binsheng Road 3333#, Hangzhou, 310052, China.
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Zhou Y, Li R, Li C, Zhou P, Li Y, Ke YH, Jiang F, Kang XP. Tübingen hip flexion splints for developmental dysplasia of the hip in infants aged 0-6 months. BMC Pediatr 2020; 20:280. [PMID: 32503452 PMCID: PMC7275443 DOI: 10.1186/s12887-020-02171-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 05/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background Developmental dysplasia of the hip (DDH) is a common disorder in infants. The present study aimed to evaluate the efficacy and safety of the Tübingen hip flexion splints in treating DDH in infants aged 0–6 months. Methods This is a retrospective study analyzing 259 hips in 195 infants with DDH of Graf type IIc or worse classifications treated between January 2015 and December 2017. Patients were followed up for at least 6 months. Avascular necrosis of the femoral head was diagnosed using plain radiographs at the last follow-up visit according to the Bucholz-Ogden classification. Successful treatment was defined as an improvement of the Graft classification to type I, or an improvement of the International Hip Dysplasia Institute classification to type I in patients aged > 6 months. Results Treatment was deemed successful in 128 patients (83.7%). Avascular necrosis occurred in 3 patients (3 hips). Univariate analysis showed that late treatment initiation, family history of DDH, Graf type IV and bilateral involvement were independent risk factors for treatment failure (p < 0.05). The receiver operating characteristic curve showed a cut-off value of 12 weeks for age at treatment initiation regarding successful treatment. Logistic regression analysis showed that gender, breech presentation, firstborn, swaddling, birth weight > 3.5 kg, oligohydramnios, foot deformity and torticollis did not affect the success rate of treatment (p > 0.05). Conclusions The Tübingen splint showed good efficacy and safety in treating DDH in infants aged 0–6 months. Family history of DDH, Graf classification of type IV, bilateral involvement and treatment initiation after 12 weeks of age are risk factors of treatment failure. Trial registration N/A
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Affiliation(s)
- You Zhou
- Department of Orthopedics, Kunming Children's Hospital, 288 Qianxing Road, Xishan District, Kunming, 650034, Yunnan, China
| | - Rong Li
- Department of Obstetrics, First Affiliated Hospital of Kunming Medical University, Kunming, 650000, China
| | - Chuan Li
- Department of Orthopedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming, 650032, China
| | - Ping Zhou
- Department of Orthopedics, Kunming Children's Hospital, 288 Qianxing Road, Xishan District, Kunming, 650034, Yunnan, China
| | - Yan Li
- Department of Orthopedics, Kunming Children's Hospital, 288 Qianxing Road, Xishan District, Kunming, 650034, Yunnan, China
| | - You-Hao Ke
- Department of Orthopedics, Kunming Children's Hospital, 288 Qianxing Road, Xishan District, Kunming, 650034, Yunnan, China
| | - Fei Jiang
- Department of Orthopedics, Kunming Children's Hospital, 288 Qianxing Road, Xishan District, Kunming, 650034, Yunnan, China
| | - Xiao-Peng Kang
- Department of Orthopedics, Kunming Children's Hospital, 288 Qianxing Road, Xishan District, Kunming, 650034, Yunnan, China.
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