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Hoffman A, Alvandi LM, Gjonbalaj E, Lo Y, Badrinath R, Fornari ED, Karkenny AJ. Child Opportunity Index and Diagnosis of Developmental Dysplasia of the Hip: Insights From a Children's Hospital Serving Disadvantaged Communities. J Am Acad Orthop Surg 2024:00124635-990000000-01016. [PMID: 38861723 DOI: 10.5435/jaaos-d-24-00417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/05/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Initiation of Pavlik harness treatment for developmental dysplasia of the hip (DDH) by 6 to 7 weeks of age predicts a higher rate of success. Child Opportunity Index (COI) 2.0 is a single metric designed to measure resources and conditions affecting children's healthy development. This study investigates COI in relation to the timing of DDH diagnosis. METHODS This is a retrospective cohort study on patients younger than 4 years diagnosed with DDH between 2016 and 2023, treated with a Pavlik harness, rigid hip abduction orthosis, and/or surgery. Demographic and clinical data were recorded, including date of first diagnostic imaging. Patients with syndromes, congenital anomalies, or neuromuscular disorders and those referred with an unknown date of first diagnostic imaging were excluded. A subgroup analysis of patients diagnosed at ≤6 weeks ("early") and >6 weeks ("late") was conducted. Statewide COI scores (total, three domains) and categorical quintile scores (very low, low, moderate, high, and very high) were recorded. RESULTS A total of 115 patients were included: 90 female infants (78%), with a median age of 32 days at diagnostic imaging. No notable difference was observed between median age at diagnosis for study patients in low or very low quintiles and those in moderate, high, or very high quintiles for COI total or domains. "Early" and "late" diagnosis subgroups did not differ markedly by COI total or domains, nor insurance type, race, or ethnicity. Subgroups differed markedly by race and insurance status. DISCUSSION In an urban children's hospital, COI did not differ markedly between patients diagnosed with DDH by ≤6 weeks and >6 weeks. This is the first study to pose this question on DDH in a population with predominantly low/very low COI scores and public insurance, which may lead to unexpected results. Replicating the study in a different setting could yield different results. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alexandra Hoffman
- From the Albert Einstein College of Medicine (Hoffman, Lo), Montefiore-Einstein and The Children's Hospital at Montefiore (Alvandi,Gjonbalaj, Fornari, Karkenny), and Jacobi Medical Center, Bronx, NY (Badrinath)
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Hockett C, Mayfield LM, Gill CS, Kim HKW, Sucato DJ, Podeszwa DA, Jo CH, Morris WZ. Does Screening Ultrasound Timing in Developmental Dysplasia of the Hip Need to be Adjusted for Moderate Preterm and Near-term Infants: A Prospective Study. J Pediatr Orthop 2024; 44:e25-e29. [PMID: 37773040 DOI: 10.1097/bpo.0000000000002540] [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: 09/30/2023]
Abstract
INTRODUCTION An initial screening ultrasound is essential for patients at higher risk of developmental dysplasia of the hip (DDH) due to breech presentation or a family history of DDH. The American Academy of Pediatrics recommends screening ultrasounds to be performed after 6 weeks of age to reduce the rate of false positives. However, there is limited evidence regarding whether these screening ultrasounds need to be adjusted for gestational age in prematurity. The purpose of this study was to evaluate the influence of moderate preterm and near-term births on screening hip ultrasounds for high-risk DDH populations. METHODS We identified all prospectively enrolled patients in a single-center database referred for screening hip ultrasound for DDH. We included those hips referred for risk factors of DDH, including breech presentation, family history of DDH, or hip click, and excluded those with known dysplasia or referral for hip instability. Each ultrasound was measured by a pediatric radiologist to determine the alpha angle and femoral head coverage. Patients were classified as "premature" if born at <37 weeks gestation or "full term" if born at ≥37 weeks gestation. All patients underwent screening hip ultrasound between 5 and 8 weeks of age. Sonographic markers of dysplasia and the incidences of abnormal ultrasound and Pavlik harness treatment were compared between cohorts. Significance was set at P <0.05. RESULTS A total of 244 hips in 122 patients were included, 58 hips in the premature cohort and 186 hips in the full-term cohort. The premature cohort had a significantly decreased gestational age compared with the full-term cohort (35.4 ± 1.1 vs 38.5 ± 1.1 wk, respectively, P < 0.001). However, there was no difference between premature and full-term cohorts in sex distribution (69% vs 75%, females, P = 0.39), unadjusted age at the time of ultrasound (6.6 ± 0.7 vs 6.8±0.7 wk, respectively, P = 0.07), or referral reason ( P = 0.14). On hip ultrasound, there was no difference between premature and full-term cohorts with respect to alpha angle (62.6 ± 3.3 vs 62.2 ± 5.3 degrees, P = 0.41), femoral head coverage (54.9 ± 6.3 vs 55.1 ± 10.6, P = 0.19), rate of abnormal ultrasound (18.3% vs 20.7%, respectively, P = 0.68), or the rate of Pavlik harness treatment (0% vs 5.3%, respectively, P = 0.12). DISCUSSION There was no significant difference in alpha angle or femoral head coverage between premature and full-term patients at 5 to 8 weeks of unadjusted age. This preliminary data suggests that screening ultrasounds can be performed without adjusting for prematurity. LEVEL OF EVIDENCE Level II, prognostic study.
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Affiliation(s)
- Claire Hockett
- Department of Orthopaedic Surgery, Scottish Rite for Children
| | | | - Corey S Gill
- Department of Orthopaedic Surgery, Scottish Rite for Children
- Department of Orthopaedic Surgery, University of Texas, Southwestern Medical Center, Dallas, TX
| | - Harry K W Kim
- Department of Orthopaedic Surgery, Scottish Rite for Children
- Department of Orthopaedic Surgery, University of Texas, Southwestern Medical Center, Dallas, TX
| | - Daniel J Sucato
- Department of Orthopaedic Surgery, Scottish Rite for Children
- Department of Orthopaedic Surgery, University of Texas, Southwestern Medical Center, Dallas, TX
| | - David A Podeszwa
- Department of Orthopaedic Surgery, Scottish Rite for Children
- Department of Orthopaedic Surgery, University of Texas, Southwestern Medical Center, Dallas, TX
| | - Chan-Hee Jo
- Department of Orthopaedic Surgery, Scottish Rite for Children
- Department of Orthopaedic Surgery, University of Texas, Southwestern Medical Center, Dallas, TX
| | - William Z Morris
- Department of Orthopaedic Surgery, Scottish Rite for Children
- Department of Orthopaedic Surgery, University of Texas, Southwestern Medical Center, Dallas, TX
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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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Wang TT, Shen PC, Chou SH, Tu PY. Risk Factors for Failure of Pavlik Harness Treatment in Infants With Dislocated Hips That Are Evaluated by Dynamic Sonography. J Pediatr Orthop 2023:01241398-990000000-00275. [PMID: 37104784 DOI: 10.1097/bpo.0000000000002418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
| | - Po-Chih Shen
- College of Medicine
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Taiwan
| | - Shih-Hsiang Chou
- College of Medicine
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Taiwan
| | - Pin-Yi Tu
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University
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Lankinen V, Helminen M, Bakti K, Välipakka J, Laivuori H, Hyvärinen A. Known risk factors of the developmental dysplasia of the hip predicting more severe clinical presentation and failure of Pavlik harness treatment. BMC Pediatr 2023; 23:148. [PMID: 37004001 PMCID: PMC10064754 DOI: 10.1186/s12887-023-03935-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/27/2023] [Indexed: 04/03/2023] Open
Abstract
PURPOSE Developmental dysplasia of the hip (DDH) varies from mild instability of the hip to subluxation or total dislocation of the joint. Well-known risk factors of DDH include pre-natal breech position, female sex, positive family history, hip side, primiparity and the mode of delivery. Aim of the present study was to further evaluate known risk-factors of DDH, find associations with more severe dysplasia (characterized with Ortolani positivity) and find risk factors of failure of the Pavlik harness treatment. MATERIAL AND METHODS All children with the diagnosis of DDH treated in Tampere University hospital in the years 1998-2018 were retrospectively identified for the study and the data was collected from the medical records. Teratological dislocations (n = 3) were excluded from the analysis. Total of 945 patients were included. RESULTS Breech presentation was strongly associated with Ortolani positivity (p < 0.001). Breech presentation was not associated with ending up for spica casting and/or operative treatment (p = 0.291) despite the association with Ortolani positivity. Ortolani positivity (p = 0.002), positive family history (p = 0.013) and girl sex (p = 0.029) were associated with ending up for spica casting and/or operative treatment. CONCLUSION Breech presentation seems to increase the risk of Ortolani positive DDH. However, these infants are likely to recover with initially started Pavlik harness treatment, as it was not associated with elevated risk for undergoing more robust treatments. Positive family history and girl sex are associated with the most severe cases of developmental dysplasia of the hip, and it may predispose to the failure of the Pavlik harness treatment.
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Affiliation(s)
- Vilma Lankinen
- Department of Pediatric Surgery, Turku University Hospital, Turku, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Mika Helminen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
- Tays Research Services, Tampere University Hospital, Tampere, Finland
| | - Karim Bakti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Hannele Laivuori
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research, Tampere University, Tampere, Finland
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna Hyvärinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Surgery, Mehiläinen Länsi-Pohja Oy, Kemi, Finland
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, Oulu, Finland
- Clinical Medicine Research Unit, Medical Research Center, University of Oulu, Oulu, Finland
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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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Andras LM, Whitlock PW, Abousamra O. What's New in Pediatric Orthopaedics. J Bone Joint Surg Am 2022; 104:299-306. [PMID: 34932502 DOI: 10.2106/jbjs.21.01430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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