Hip morphology on initial ultrasound predicts hip morphology at one year in developmental dysplasia of the hip

Purpose:

This study aimed to determine whether point-of-care ultrasound performed during the Pavlik method treatment of developmental dysplasia of the hip predicts acetabular morphology at 12 months of age.

Methods:

We reviewed the medical records, ultrasounds, and radiographs of patients treated successfully with the Pavlik method between 2017 and 2019. We performed sonographic measurements on point-of-care ultrasound at the initial presentation, the Pavlik discontinuation, and an additional sonographic follow-up. We measured the acetabular index on a plain anteroposterior radiograph of the pelvis obtained at a minimum of 12 months of age. Spearman’s rank correlation coefficient was used to analyze for correlation between sonographic measurements and the acetabular index.

Results:

A total of 72 patients were included in the final analysis. There were no residual or late dysplasia cases at the last radiographic follow-up (mean age = 14.8 ± 2.7 months). Sonographic parameters at the initial presentation significantly correlated with the acetabular index at the final radiographic follow-up (p < 0.001). Patients with worsening degrees of developmental dysplasia of the hip based on stability on sonographic testing (stable, unstable, or dislocated) had higher acetabular indices at the final radiographic follow-up (p < 0.05).

Conclusion:

Point-of-care ultrasound at initial presentation and the Pavlik discontinuation significantly correlate with acetabular morphology at 1–1.5 years of age. At initial presentation, hips that were unstable or dislocated on point-of-care ultrasound had significantly greater acetabular indices than stable hips at the final follow-up.

Level of evidence:

level IV case series.

Can Medialization of Acetabular Rim Be a Prognostic Factor in Treatment of Developmental Dysplasia of Hip?

OBJECTIVES

To investigate if acetabular rim medialization (ARM) can be used as a new parameter in determining the treatment choice and duration in Graf type III and IV hips.

METHODS

Among the 12,300 infants who underwent hip ultrasound (US) according to Graf's method between 2015 and 2019, 26 infants (9 had bilateral pathology hence 35 hips) with type III and IV hips, whose follow-up data could be obtained were included in the study. Age of the infants at the initial diagnosis, ARM measurement, the duration of harness treatment, and the treatment results were noted. To determine the extent of ARM, distance between a line that is drawn tangential to the iliac wing and acetabular rim was measured.

RESULTS

In cases with poor prognosis, ARM measurement was 6 to 8.5 mm on the right hip and 4 to 9 mm on the left hip. Bilaterality or unilaterality, left or right pathology, and gender did not have a significant effect on the prognosis (P >.05). Age at the initial diagnosis and ARM had significant effects on treatment success (P = .04, P = .00, respectively). In predicting the prognosis, ARM was found to be more successful than age (AUC = 0.95 versus AUC = 0.68). When these two variables were evaluated together, the success in predicting the prognosis significantly increased (AUC = 0.98).

CONCLUSIONS

ARM measurement may have an important role in determining the treatment method and duration in Graf type III and IV hips. It can be used as a prognostic factor alone or in combination with treatment initiation time. When the two factors are combined, prognostic value significantly increases.

Outcomes of ultrasound-monitored treatment of divelopmental dysplasia of the hip graf type II

Introduction: The management of developmental dysplasia of the hips (DDH) type Graf IIa is still controversial. This study aims to examine the outcomes of ultrasound-monitored Pavlik harness treatment, as well as the effects of associated factors, such as gender, side of DDH, the age at the treatment start, and laterality on the treatment outcomes in different Graf type II subtypes. Methods: A cohort retrospective investigation was performed on 88 ultrasound-screened infants or 125 hips diagnosed with Graf type II dysplasia during a six-month period at a single institution, the University Clinic for Orthopedic Surgery, Skopje. Subsequently, 47 infants (18 boys, 29 girls) or 73 hips who underwent Pavlik harness treatment with at least one follow-up throughout treatment monitoring were included in this study. Results: The treatment success rate of the right DDH Graf type IIa (-) was higher (70.8%) compared to the rate of success (50%) in the treatment of left Graf type IIa (-) hips. The mean age of the infants at the treatment start in successfully treated Graf type IIa (-) hips was lower (9.12 ± 2.27 weeks) compared to the age of the infants with treatment failure at the last follow-up (11.33 ± 3.06 weeks), P = 0.04. Conclusion: The age of treatment initiation and the side of DDH were the most relevant factors related to the treatment outcome. Infants with maturational deficit hips, Graf type IIa (-), should undergo early initiated, carefully guided, and monitored Pavlik harness treatment.