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Walter SG, Ossendorff R, Bornemann R, Zarghooni K, Peterlein CD, Placzek R. Mid-term Follow-Up after Closed Reduction in Developmental Dysplastic Hips. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:52-56. [PMID: 35839820 DOI: 10.1055/a-1865-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Closed reduction and subsequent spica casting is the gold standard for treatment of unstable or dislocated developmental dysplastic hips (DDHs). There are few data on mid-term results after treatment of DDH, especially on closed reduction. METHODS Thirty-one consecutive patients with unstable or dislocated hips (n = 36) that were treated by fluoroscopic, contrast agent-supported closed reduction and spica casting were included and evaluated clinically and radiologically 2 and 5 years after treatment. RESULTS After 2 and 5 years, there were no significant differences between healthy and successfully treated hips that were detectable with respect to acetabular coverage (AC) angle, center-edge angle, and clinical stability of the hip. There was a significant difference at the 2-year follow-up between healthy hips and hips that needed to undergo secondary open reduction surgery (n = 4) with respect to the AC angle (p < 0.001). CONCLUSION Closed reduction in DDHs results in acceptable clinical and radiological results in the mid-term follow-up. It remains unclear why some patients with subsequent sonographically matured hips show secondary deterioration and recurrence of dysplasia.
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Affiliation(s)
- Sebastian G Walter
- Department of Orthopedic Surgery and Traumatology, University Hospital Cologne, Köln, Germany
| | - Robert Ossendorff
- Department of Orthopedic Surgery and Traumatology, University Hospital Bonn, Bonn, Germany
| | - Rahel Bornemann
- Department of Orthopedic Surgery and Traumatology, University Hospital Bonn, Bonn, Germany
| | - Kourosh Zarghooni
- Department of Orthopedic Surgery and Traumatology, University Hospital Cologne, Köln, Germany
| | | | - Richard Placzek
- Department of Orthopedic Surgery and Traumatology, University Hospital Bonn, Bonn, Germany
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Aw AAL, Wong KPL, Lee NKL, Mahadev A. The utility of ultrasound and plain radiographs in the management of developmental dysplasia of the hip. J Pediatr Orthop B 2024; 33:9-15. [PMID: 36943691 DOI: 10.1097/bpb.0000000000001078] [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: 03/23/2023]
Abstract
The purpose of this study is to assess the utility of follow-up radiological imaging in the management of developmental dysplasia of the hip (DDH) in patients successfully treated with the Pavlik harness. A retrospective review was conducted on all children under 6 months diagnosed with DDH at a tertiary pediatric hospital between January 2004 and December 2018. Inclusion criteria included successful Pavlik harness treatment following a standardized protocol with complete radiological documentation at 2 years of age. Ultrasonography was reviewed to measure the α and β angles and Graf classification. Anteroposterior pelvic radiographs were evaluated for the acetabular index and residual acetabular dysplasia. Seventy-eight hips from 57 infants were included in this study. The mean 6-month, 12-month and 2-year acetabular index of Graf I, IIa and IIc hips on ultrasound at 12 weeks were within the normal range according to age. There were no Graf IIb, IId, III and IV hips. All infants had normal radiographs at 2 years follow-up. The 6- and 12-month residual dysplasia rates in patients with DDH normalization at 12 weeks and 6 months range from 2.5 to 8.82%. Regardless of when the acetabular index normalized, all patients eventually had normal hip radiographs at 2 years of age. Following a standardized protocol, patients undergoing Pavlik harness treatment for DDH with Graf I and IIa hips at 12 weeks are likely to have normal plain radiographs at discharge. The incidence of residual dysplasia is very low and hence, radiographic surveillance is probably unnecessary until discharge at 2 years. Level II, retrospective study.
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Affiliation(s)
- Angeline Ai Ling Aw
- Faculty of Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University
| | - Kenneth Pak Leung Wong
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Nicole Kim Luan Lee
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Arjandas Mahadev
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
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Li Y, Wang Z, Miao M, Xu Y, Shi J. Residual acetabular dysplasia after Pavlik harness treatment for Graf type II hips. J Child Orthop 2023; 17:306-314. [PMID: 37565002 PMCID: PMC10411375 DOI: 10.1177/18632521231182423] [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: 01/08/2023] [Accepted: 05/29/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose To evaluate the residual acetabular dysplasia in Graf type II hips after Pavlik harness treatment with a radiographic follow-up at 2 years of age. Methods We retrospectively reviewed the developmental dysplasia of the hip patients who were treated with the Pavlik harness between March 2018 and February 2022. Patients with Graf type II hip dysplasia who had at least one radiographic follow-up after 2 years of age were included. The following information, sex, laterality, affected side, age at harness initiation, treatment duration, α angle, and the morphology of bony roof, was collected and studied. We evaluated the radiographic acetabular index at the last follow-up and defined the value of greater than 2 standard deviations as residual acetabular dysplasia. Results A total of 33 patients (53 hips) met the criteria. The mean initial α angle was 53.4°; the mean age at Pavlik harness initiation was 10.9 weeks. The mean treatment duration was 10 weeks. The mean α angle at the last ultrasound follow-up was 64.9°. The mean age of the last radiographic follow-up was 2.6 years, and 26 hips had a residual acetabular dysplasia with acetabular indexes greater than 2 standard deviations above the mean. The morphology of the acetabular bony rim (odds ratio = 4.333, P = 0.029) and age of initial treatment <12 weeks (odds ratio = 7.113, P = 0.014) were seen as significant predictors for a higher acetabular index more than 2 years of age. Conclusions A notable incidence of residual acetabular dysplasia after Pavlik harness treatment in Graf type II hips, wherein the acetabular bony roof with a blunt rim at the end of treatment and initial age after 12 weeks were independent predictors associated with residual acetabular dysplasia. Levels of evidence Therapeutic studies, IV.
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Affiliation(s)
- Yuchan Li
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhigang Wang
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingyuan Miao
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunlan Xu
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Shi
- Department of Radiology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Li Y, Canavese F, Liu Y, Wu J, Li J, Yuan Z, Xu H. Incidence and risk factors for persistent acetabular dysplasia in patients with developmental dislocation of the hip treated by Pavlik Harness. J Pediatr Orthop B 2023; 32:312-317. [PMID: 35703163 DOI: 10.1097/bpb.0000000000000992] [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: 11/27/2022]
Abstract
Some patients with developmental dysplasia of the hip (DDH) before 6 months of age successfully treated by Pavlik Harness (PH) still had persistent acetabular dysplasia (PAD). This study aimed to investigate the incidence and risk factors for PAD in patients with DDH treated by PH. We retrospectively reviewed the data of 89 patients (109 hips; mean age, 3.2 ± 1.5 months) with DDH treated by PH. Prior to treatment, all patients underwent ultrasound examination and classified according to Graf's method. PH was terminated once the hip achieved imaging recovery criteria. At final follow-up, the acetabular index (AI), center-edge angle (CEA) of Wiberg were measured on radiograph. Overall, 67/109 hips (61.5%) had successful PH treatment. Among these 67 hips, 58 hips (86.6%) achieved satisfactory outcome, nine (13.4%) had PAD. Age of the patients with PAD (4.3 ± 1 months) was significantly higher than those without PAD (2.8 ± 1.5 months) ( P = 0.001). Hips with PAD had higher mean Graf grade than those with satisfactory outcome ( P = 0.014). Logistic regression-confirmed age and Graf classification were risk factors for PAD. Overall, 55/67 (82.1%) met imaging recovery criteria to stop PH treatment, whereas 12/67 hips (17.9%) did not. The rate of PAD at final follow-up in patients achieving recovery criteria (4/55; 7.3%) was significantly lower than those not achieving it (41.7%) ( P = 0.007). In conclusion, age and Graf classification are risk factors for PAD. If hips are not normal at the end of PH treatment, the risk of PAD increases further.
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Affiliation(s)
- YiQiang Li
- GuangZhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou, China
| | - Federico Canavese
- GuangZhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou, China
- Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, Lille, France
| | - YanHan Liu
- GuangZhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou, China
| | - JianPing Wu
- GuangZhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou, China
| | - JingChun Li
- GuangZhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou, China
| | - Zhe Yuan
- GuangZhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou, China
| | - HongWen Xu
- GuangZhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou, China
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Residual dysplasia of the hip after successful ultrasound-monitored treatment: how does an infant's hip evolve? J Pediatr Orthop B 2022; 31:524-531. [PMID: 35502735 DOI: 10.1097/bpb.0000000000000984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite that normal values for the hip joint are reached at the end of ultrasound-monitored-treatment, the development of the acetabulum can be compromised during the growth phase. The acetabular index (AI) measured on a pelvic radiograph has been proven to be a reliable parameter. The aim of this study is to gain a better understanding of the dynamics of once-treated, residually dysplastic hips. This should be achieved by radiographically following these hips up to a milestone-examination at the end of preschool age. A total of 120 hips of consecutive 60 infants were included in this examination, each presenting with a residual developmental dysplasia of the hips (DDH) after successful ultrasound-monitored harness treatment. Radiographic follow-up was assessed retrospectively around 18 months, 3 years and 6 years of age, and the AI was measured. The age-dependent Tönnis classification was applied. The hips were assigned normal, mildly or severely dysplastic. Dependent t -test for paired samples indicated a highly significant improvement of the AI-values, including from the first to the second and from the second to the third follow-up. The percentage distribution into the Tönnis classification changed remarkably: in the first follow-up, 36 of the 120 hips were evaluated 'severely dysplastic', in the third follow-up only 1. On the other hand, three hips underwent acetabuloplasty. Even after normal values have been achieved at the end of ultrasound-monitored treatment, there remains a risk of residual dysplasia of the hips. Particularly, when the first radiographic examination shows nonphysiological findings, further close-meshed follow-up is recommended. Level of evidence: retrospective study of therapeutic outcome, consecutive patients, level II.
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Salton RL, Carry P, Freeman T, Holmes K, Miller NH, Kohuth B, Burke D, Belton M, Murphy-Zane MS, Georgopoulos G. Twelve-week standard of care protocol longer than median time to normalization among IIc hips treated with Pavlik harness. J Pediatr Orthop B 2022; 31:313-318. [PMID: 35102060 DOI: 10.1097/bpb.0000000000000946] [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: 02/10/2023]
Abstract
Best treatment protocols for infants with developmental dysplasia of the hip (DDH) are poorly defined. This study estimates the time to normalization among Graf IIc hips undergoing Pavlik harness treatment. Following institutional review board approval, patients referred for DDH evaluation at a pediatric institution between 2009 and 2018 (n = 1424 hips/712 patients) were identified. We isolated all Graf IIc hips that underwent Pavlik harness treatment (n = 132 hips/n = 106 patients). Demographic and outcome measures were collected. Normalization was defined as alpha angle greater than or equal to 60° and femoral head coverage greater than or equal to 50%. Kaplan-Meier and Cox proportional hazards regression analyses modeled time to normalization and identified factors associated with earlier normalization. Median time to normalization was 7.0 weeks. At 12 weeks standard treatment, 85.8% [95% confidence interval (CI): 80.2-91.9%] had normalized. Greater femoral head coverage [hazard ratio (HR) per 1% increase: 1.03; 95% CI: 1.01-1.05; P = 0.0068] and hip stability at treatment initiation (HR unstable vs. stable: 0.64; 95% CI: 0.44-0.93; P = 0.0192) were associated with longer time to normalization. Some patients may not need 12 weeks of Pavlik bracing, particularly those with stable presentation who normalize before week 12. Shorter treatment lengths offer benefit without sacrificing long-term outcomes. Findings reinforce growing evidence that femoral head coverage should be a more significant consideration during diagnosis and instability is a concerning finding on examination.
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Affiliation(s)
- Reba L Salton
- Musculoskeletal Research Center, Orthopedics Institute, Children's Hospital Colorado
| | - Patrick Carry
- Musculoskeletal Research Center, Orthopedics Institute, Children's Hospital Colorado
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
| | - Tyler Freeman
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
| | - Kaley Holmes
- Musculoskeletal Research Center, Orthopedics Institute, Children's Hospital Colorado
| | - Nancy H Miller
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Brian Kohuth
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Deborah Burke
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Matthew Belton
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
| | - Margaret Siobhan Murphy-Zane
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Gaia Georgopoulos
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
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Hip Morphology in Periacetabular Osteotomy (PAO) Patients Treated for Developmental Dysplasia of the Hip (DDH) as Infants Compared With Those Without Infant Treatment. J Pediatr Orthop 2022; 42:e565-e569. [PMID: 35667051 DOI: 10.1097/bpo.0000000000002137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A subset of patients successfully treated for developmental dysplasia of the hip (DDH) as infants have symptomatic acetabular dysplasia at skeletal maturity leading to periacetabular osteotomy (PAO). The purpose of this study was to compare femoral and acetabular morphology in PAO patients with late acetabular dysplasia after previous treatment for DDH with PAO patients who do not have a history of DDH treatment. METHODS A single surgeon's patients who underwent PAO between 2011 and 2021 were retrospectively reviewed. Patients previously treated for infantile DDH with a Pavlik harness, abduction brace, closed reduction and spica casting, or open reduction and spica casting were included. Patients with previous bony hip surgery were excluded. Preoperative radiographic measurements of each hip were recorded including lateral center edge angle, anterior center edge angle, and Femoro-Epiphyseal Acetabular Roof index. Computed tomography measurements included the coronal center edge angle, sagittal center edge angle, Tönnis angle, acetabular anteversion at 1, 2, and 3 o'clock, femoral neck-shaft angle, femoral version, and alpha angle. Control PAO cases without a history of DDH diagnosis or treatment were matched with the infantile DDH treatment group in a 2:1 ratio based on coronal center edge angle, age, and sex. RESULTS There were 21 hips in 18 patients previously treated for infantile DDH (13 patients Pavlik harness, 3 abduction brace, 1 closed reduction, and 1 open reduction). The control PAO cohort was 42 hips in 42 patients who did not have previous DDH treatment. There was no statistically significant difference in any of the recorded measurements between patients previously treated for DDH and those without previous treatment including femoral version (P=0.494), anteversion at 1 o'clock (P=0.820), anteversion at 2 o'clock (P=0.584), anteversion at 3 o'clock (P=0.137), neck-shaft angle (P=0.612), lateral center edge angle (P=0.433), Femoro-Epiphyseal Acetabular Roof index (P=0.144), and alpha angle (P=0.156). CONCLUSIONS Femoral and acetabular morphology is similar between PAO patients with persistent symptomatic acetabular dysplasia following DDH treatment and patients presenting after skeletal maturity with acetabular dysplasia and no previous history of DDH treatment. LEVEL OF EVIDENCE Level III-case-control, prognostic study.
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Li Y, Canavese F, Liu Y, Wu J, Li J, Yuan Z, Zhou Q, Liu Y, Chen W, Xu H. Does a Graf Type-I Hip Justify the Discontinuation of Pavlik Harness Treatment in Patients with Developmental Dislocation of the Hip? CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050752. [PMID: 35626929 PMCID: PMC9139830 DOI: 10.3390/children9050752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
Abstract
Background: To analyze the clinical data of patients aged < 6 months with developmental dislocation of the hip (DDH) treated with Pavlik Harness (PH) in order to identify the best time to terminate PH treatment. Method: Fifty-four patients (47 females, 7 males; 63 hips) met the inclusion criteria and were included in the study; there were 33 (61.1%) left, 12 (22.2%) right and 9 (16.7%) bilateral DDH. The mean age at diagnosis was 11.8 ± 5.9 weeks (range, 1.4−25.5). All patients underwent fulltime PH treatment for about three months. At completion of PH treatment, patients were then divided into Group A, including patients with clinically stable hip joint and Graf type-I hip on ultrasound (US), and Group B, including patients with clinically stable hip joint and well-reduced hip on anterior-posterior (AP) radiographs without acetabular dysplasia. Six months after completion of PH treatment, the presence/absence of residual acetabular dysplasia (RAD) was evaluated on AP pelvis radiographs. The t-test and chi-square test were used to compare the differences in age, gender, side, Graf classification and RAD rate between the two groups of patients. Results: At completion of PH treatment, 45 hips were in Group A and 18 in Group B. There were no significant differences in age, gender, side, preoperative alpha angle and Graf classification between the two groups. Six months after discontinuation of PH, the AI in Group A (27.1° ± 6.8°) was significantly higher than that in Group B (21.9° ± 3.5°; p = 0.001); moreover 23 hips (51.1%) in Group A developed RAD compared to one hip in Group B (5.6%; p = 0.001). Among Group A patients, those with RAD were significantly older (13.7 ± 4.9 weeks) than those with normal hips (7.6 ± 3.8 weeks; p < 0.001); the incidence of RAD was significantly lower in patients with Graf type-II D hips (22.2%) than in patients with Graf type-III (70%) and type-IV hips (71.4%; p = 0.006). However, logistic regression analysis identified age as the only risk factor for RAD. All 24 hips with RAD (24/63, 38.1%) were treated with abduction braces. At final follow-up, AI in Group A (20.5° ± 3.3°) was not significantly different from that in Group B (21.9° ± 3.3°; p = 0.132). At the last follow-up visit, five hips (11.1%) in Group A still had RAD, compared to none in Group B (p = 0.31). Conclusions: In patients with DDH treated by PH, Graf type-I on US is not an absolute timing to terminate PH treatment. In addition, patients ≥ 13 weeks had a high risk of RAD despite PH treatment as 51.1% of infants developed RAD during follow up. Follow-up radiographs should be requested in all patients achieving Graf type-I hips at completion of PH treatment.
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Affiliation(s)
- Yiqiang Li
- Department of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China; (Y.L.); (Y.L.); (J.W.); (J.L.); (Z.Y.); (Q.Z.); (Y.L.); (W.C.)
| | - Federico Canavese
- Department of Pediatric Surgery and Orthopedics, Jeanne de Flandre Hospital, Lille University Center, 59800 Lille, France;
| | - Yanhan Liu
- Department of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China; (Y.L.); (Y.L.); (J.W.); (J.L.); (Z.Y.); (Q.Z.); (Y.L.); (W.C.)
| | - Jianping Wu
- Department of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China; (Y.L.); (Y.L.); (J.W.); (J.L.); (Z.Y.); (Q.Z.); (Y.L.); (W.C.)
| | - Jingchun Li
- Department of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China; (Y.L.); (Y.L.); (J.W.); (J.L.); (Z.Y.); (Q.Z.); (Y.L.); (W.C.)
| | - Zhe Yuan
- Department of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China; (Y.L.); (Y.L.); (J.W.); (J.L.); (Z.Y.); (Q.Z.); (Y.L.); (W.C.)
| | - Qinghe Zhou
- Department of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China; (Y.L.); (Y.L.); (J.W.); (J.L.); (Z.Y.); (Q.Z.); (Y.L.); (W.C.)
| | - Yuanzhong Liu
- Department of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China; (Y.L.); (Y.L.); (J.W.); (J.L.); (Z.Y.); (Q.Z.); (Y.L.); (W.C.)
| | - Weidong Chen
- Department of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China; (Y.L.); (Y.L.); (J.W.); (J.L.); (Z.Y.); (Q.Z.); (Y.L.); (W.C.)
| | - Hongwen Xu
- Department of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China; (Y.L.); (Y.L.); (J.W.); (J.L.); (Z.Y.); (Q.Z.); (Y.L.); (W.C.)
- Correspondence: ; Tel./Fax: +86-20-38076158
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Sioutis S, Kolovos S, Papakonstantinou ME, Reppas L, Bekos A, Koulalis D, Mavrogenis A. Developmental dysplasia of the hip: a review. J Long Term Eff Med Implants 2022; 32:39-56. [DOI: 10.1615/jlongtermeffmedimplants.2022040393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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10
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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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11
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Baghdadi S, Sankar WN. Residual Acetabular Dysplasia in the Reduced Hip. Indian J Orthop 2021; 55:1480-1489. [PMID: 35003538 PMCID: PMC8688620 DOI: 10.1007/s43465-021-00515-1] [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] [Received: 07/19/2021] [Accepted: 09/04/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Residual acetabular dysplasia occurs in up to a third of patients treated successfully for developmental dysplasia of the hip (DDH) and has been found to be a significant risk factor for early hip osteoarthritis (OA). DISCUSSION Age at the time of initial reduction and the initial severity of DDH have been linked to residual acetabular dysplasia. An anteroposterior pelvic radiograph is the main diagnostic modality, but MRI also provides valuable information, particularly in equivocal cases. The literature supports intervening when significant residual acetabular dysplasia persists at 4-5 years of age, and common surgical indications include acetabular index (AI) > 25°-30°, lateral center-edge angle (LCEA) < 8°-10°, and a broken Shenton's line on radiographs; and a cartilaginous acetabular angle (CAI) > 18°, cartilaginous center-edge angle (CCE) < 13°, and/or the presence of high-signal intensity areas on MRI. Surgical options include redirectional pelvic osteotomies and reshaping acetabuloplasties, which provide comparable radiographic and clinical results. CONCLUSION RAD is common after treatment of DDH and requires regular follow-up for diagnosis and appropriate management to decrease the long-term risk of OA. Long-term outcomes of patients treated with pelvic osteotomies are generally favorable, and the risk of OA can be decreased, although the risk of total hip replacement in the long-term remains.
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Affiliation(s)
- Soroush Baghdadi
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Wudbhav N. Sankar
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, PA USA
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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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Theunissen WW, van der Steen M, van Douveren FQ, Witlox AM, Tolk JJ. Timing of Repeat Ultrasound Examination in Treatment of Stable Developmental Dysplasia of the Hip. J Pediatr Orthop 2021; 41:203-208. [PMID: 33655899 PMCID: PMC8048726 DOI: 10.1097/bpo.0000000000001766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Worldwide a wide variation exists in duration of Pavlik harness treatment for infants up to 6 months with stable developmental dysplasia of the hip (DDH). The purpose of this study was to evaluate whether shortening the time to first routine follow-up ultrasound after initiation of Pavlik harness treatment would reduce treatment duration and whether this influenced radiologic outcome at 1 year of age. Furthermore, predictors of higher acetabular index (AI) at 1 year of age were investigated. METHODS A retrospective study was conducted in infants with stable DDH (Graf IIb and IIc) diagnosed and treated between 2015 and 2017. Two groups were identified: first routine follow-up ultrasound at 12 weeks after Pavlik harness initiation (group I) and first routine follow-up ultrasound at 6 weeks after Pavlik harness initiation (group II). In both groups, treatment was continued until repeat ultrasound measurements (every 6 wk) showed a normalized hip. Radiologic outcome at 1 year of age was defined as residual dysplasia measured on an anteroposterior hip radiograph according to the Tönnis table. RESULTS A total of 222 infants were included. The median time of Pavlik harness treatment was 12 weeks (interquartile range, 11.9 to 12.3) in group I compared with 6.1 weeks (interquartile range, 6.0 to 7.5) in group II (P<0.001). Residual dysplasia at 1 year of age was detected in 20 infants (16.8%) in group I compared with 11 infants (10.7%) in group II (P=0.189). The multivariable prediction model showed that positive family history and lower baseline alpha angle correlate with a higher AI at 1 year of age. CONCLUSIONS First routine follow-up ultrasound can be safely brought forward from 12 to 6 weeks after Pavlik harness initiation. Furthermore, infants with a positive family history for DDH and an initial low alpha angle are at higher risk to have a higher AI at 1 year of age. LEVEL OF EVIDENCE Level III-retrospective study.
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Affiliation(s)
| | - Marieke van der Steen
- Department of Orthopaedic Surgery and Trauma, Máxima MC, Veldhoven
- Department of Orthopaedic Surgery, Catharina Hospital, Eindhoven
| | | | - Adhiambo M.A. Witlox
- Department of Orthopaedic Surgery and Trauma, Máxima MC, Veldhoven
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jaap J. Tolk
- Department of Orthopaedic Surgery and Trauma, Máxima MC, Veldhoven
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Should I Plan to Open? Predicting the Need for Open Reduction in the Treatment of Developmental Dysplasia of the Hip. J Pediatr Orthop 2020; 40:e329-e334. [PMID: 31385896 DOI: 10.1097/bpo.0000000000001429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Closed reduction is generally attempted on children under 18 months of age who present as older infants or who fail nonoperative management for developmental dysplasia of the hip (DDH). However, many of these patients will not achieve concentric reduction by closed means and will ultimately require open reduction (OR). Limited evidence exists to predict which patients can be adequately closed reduced versus those who will need open treatment. METHODS Prospectively collected data from 4 select centers of an international multicenter study group sharing a common treatment approach were reviewed for all DDH infants under 18 months old that required operative management. Patients were categorized into 2 groups: those whose hips were successfully closed reduced or those who ultimately required OR. Factors were compared between the closed reduction and OR groups for 2 separate cohorts-those presenting early in life with ultrasound (US) data, and those presenting later with radiographic data. RESULTS A total of 154 patients (166 hips) were included in the analysis. Overall, 87.3% were female. In the early-presenting cohort, purposeful entry multivariate regression revealed that patients with Graf IV hips on US had 3.8 times higher odds of requiring an OR. For the later cohort, hips that were clinically irreducible (ie, negative Ortolani sign) had 3.3 times higher odds of requiring OR. Patients with International Hip Dysplasia Institute (IHDI) grade IV hips had 2.5 times higher odds of needing an OR versus those with grade III hips and 15.4 times higher odds than those with grade II hips. Children with an IHDI grade IV hip and a negative Ortolani sign had 4.4 times higher odds of needing OR. CONCLUSION Children younger than 18 months with dislocated hips who require OR are more likely to have a high-grade radiographic dislocation (IHDI grade IV), negative preoperative Ortolani sign, and a Graf IV classification on initial US. This information may help surgeons budget the use of operating room time and better counsel parents about intraoperative expectations. LEVEL OF EVIDENCE Level III-Prognostic.
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Yang S, Zusman N, Lieberman E, Goldstein RY. Developmental Dysplasia of the Hip. Pediatrics 2019; 143:peds.2018-1147. [PMID: 30587534 DOI: 10.1542/peds.2018-1147] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2018] [Indexed: 11/24/2022] Open
Abstract
Pediatricians are often the first to identify developmental dysplasia of the hip (DDH) and direct subsequent appropriate treatment. The general treatment principle of DDH is to obtain and maintain a concentric reduction of the femoral head in the acetabulum. Achieving this goal can range from less-invasive bracing treatments to more-invasive surgical treatment depending on the age and complexity of the dysplasia. In this review, we summarize the current trends and treatment principles in the diagnosis and treatment of DDH.
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Affiliation(s)
- Scott Yang
- Department of Orthopedics and Rehabilitation, Doernbecher Children's Hospital and Oregon Health and Science University, Portland, Oregon; and
| | - Natalie Zusman
- Department of Orthopedics and Rehabilitation, Doernbecher Children's Hospital and Oregon Health and Science University, Portland, Oregon; and
| | - Elizabeth Lieberman
- Department of Orthopedics and Rehabilitation, Doernbecher Children's Hospital and Oregon Health and Science University, Portland, Oregon; and
| | - Rachel Y Goldstein
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, California
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Kubo H, Pilge H, Holthoff JP, Hufeland M, Westhoff B, Krauspe R. Poorer radiological outcome after delayed diagnosis and treatment in human position in Fettweis plaster cast in 93 unstable hip joints type D, III and IV according to Graf. J Child Orthop 2018; 12:590-598. [PMID: 30607206 PMCID: PMC6293336 DOI: 10.1302/1863-2548.12.180132] [Citation(s) in RCA: 5] [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] [Indexed: 02/03/2023] Open
Abstract
PURPOSE In this study the course of unstable hips after successful treatment with Fettweis plaster of Paris (POP) is examined. Special focus will be given to age at beginning of treatment and initial hip type. METHODS The development of 93 unstable hips treated between November 2001 and April 2015 was examined. Inclusion criteria were: 1) unstable hips with successful treatment with Fettweis POP; 2) presence of two pelvic radiographs (12 to 24 months and 24 to 48 months). We analyzed: 1) the initial ultrasound hip type according to Graf; 2) the average age at first and second radiograph; 3) the Tönnis classification: normal findings (< 1 SD), slightly (1 SD to 2 SD) and severely dysplastic hips (> 2 SD). RESULTS In all, there were 14 hips type D, 41 hips type III and 38 hips type IV. Mean age of the first radiograph was 13.9 months and of the second 28.5 months. The first radiograph showed: (< 1 SD): 36, (1 SD to 2 SD): 34, (> 2 SD): 23 hips, the second radiograph: (< 1 SD): 33, (1 SD to 2 SD): 19, (> 2 SD): 30 hips. With subdivision at the start of treatment at age eight or fewer weeks 2/16 hips (12.5%) and with initiation of the treatment more than eight weeks 22/77 (26.0%) deteriorated. During the course between first and second radiograph a total of 35.7% of initial hip type D, 19.5% of type III and 23.7% of type IV deteriorated. CONCLUSION Radiograph controls after treatment with Fettweis POP show poorer outcome after delaying the start of treatment more than 8 weeks. These findings were independent of the initial ultrasound hip type. Regular radiograph controls of all hip types treated for unstable hips are justified to detect residual dysplasia. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- H. Kubo
- University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Düsseldorf, Germany,Correspondence should be sent to H. Kubo, University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Düsseldorf, Germany. E-mail:
| | - H. Pilge
- University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Düsseldorf, Germany
| | - J.-P. Holthoff
- University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Düsseldorf, Germany
| | - M. Hufeland
- University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Düsseldorf, Germany
| | - B. Westhoff
- University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Düsseldorf, Germany
| | - R. Krauspe
- University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Düsseldorf, Germany
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