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Giorgi V, Apostolo G, Bertelè L. Treatment of developmental hip dysplasia with manual therapy following Pavlik harness failure: a case report with long-term follow-up. J Man Manip Ther 2024:1-10. [PMID: 38706305 DOI: 10.1080/10669817.2024.2349334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a common musculoskeletal disorder in newborns, ranging from mild dysplasia to complete dislocation. Early detection and intervention are crucial for managing DDH. However, in some cases, standard orthopedic treatments such as the Pavlik harness fail, and alternative approaches are needed. Our study explores the possibility that manual therapy, specifically the Mézières-Bertelè Method (MBM), could be beneficial in cases of DDH that are resistant to conventional treatments. CASE DESCRIPTION We present a case of a 20-month-old female who had been suffering from persistent DDH (Graf's type IIIC on the left), pain and limping, despite previous conventional treatments, including the Pavlik harness. The patient received daily MBM sessions for six months, followed by maintenance sessions every two months. OUTCOMES After undergoing the MBM treatment, the patient showed clinical improvements, such as normal neuromotor development and restored hip joint parameters. We observed normal walking and running abilities, and X-ray parameters returned to normal levels. The patient sustained positive outcomes during long-term follow-up until the age of 7. CONCLUSION The MBM manual therapy was used to treat a challenging case of DDH resistant to conventional treatment. This case report suggests a possible correlation between manual therapy and improved outcomes in resistant DDH and highlights the potential relevance of addressing the inherent musculoskeletal components of the condition.
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Affiliation(s)
- Valeria Giorgi
- Rehabilitation Center, Apostolo Foundation, Lecco, Italy
| | | | - Laura Bertelè
- Rehabilitation Center, Apostolo Foundation, Lecco, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Dragonas CG, Kottaridou E, Vampertzis T, Abbakr L, Taha N, Manoukian D. Length of treatment and ultrasound timing in infants with developmental dysplasia of the hip. Eur J Orthop Surg Traumatol 2024; 34:1079-1086. [PMID: 37934277 DOI: 10.1007/s00590-023-03771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Developmental dysplasia of the hip (DDH) joint is a complex condition that may lead to severe problems. Ultrasound scan (USS) in the first four-to-six weeks of life is considered the gold-standard for diagnosis while the Pavlik harness (PH) is a widely utilized method as first-line treatment. The purpose of this study is to compare clinical outcomes of infants with DDH in relation to the timing and frequency of USS following application of the PH. METHODS Retrospective data were collected over a 5-year period from February 2017 to February 2022. We included patients who underwent the first USS post-diagnosis and PH application in two, three, four and six weeks. Two-hundred-twenty-five patients were included and divided in four groups according to timing of the first follow-up: week-2, n = 13; week-3, n = 66; week-4, n = 95; and week-6, n = 51. For every patient Graf classification, treatment length and number of follow-ups were documented. RESULTS Week-3 and week-4 groups displayed a statistically significant shorter treatment length compared to week-6 group (p value < 0.001), while also demonstrating a lower number of sonographic follow-ups per patient compared to both week-6 (p value < 0.001) and week-2 (p value = 0.002 vs week-3; p value < 0.001 vs week 4). Week-4 group presented the highest treatment completion (56%) on first visit post-diagnosis. Conservative treatment with PH failed in 1.8% (4/225) and displayed no significant difference among all subgroups. CONCLUSIONS Differences in timing of first USS post-DDH diagnosis and initiation of treatment can lead to discrete outcomes with implications to the clinical outcome and cost effectiveness.
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Affiliation(s)
| | | | - Themistoklis Vampertzis
- The Royal London Hospital, Barts Health Trust, London, UK
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lina Abbakr
- Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, CM20 1QX, UK
| | - Narmeen Taha
- Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, CM20 1QX, UK
| | - Dimitrios Manoukian
- Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, CM20 1QX, UK
- The Royal London Hospital, Barts Health Trust, London, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Yasin MS, Al Karmi J, Suleiman DO, Raja YM, Alshrouf MA, Abu Halaweh A, Hamdan M, Samarah O. Acetabular index as an indicator of Pavlik harness success in grade I developmental dysplasia of the hip: A retrospective study. J Child Orthop 2023; 17:598-606. [PMID: 38050594 PMCID: PMC10693839 DOI: 10.1177/18632521231199519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/16/2023] [Indexed: 12/06/2023] Open
Abstract
Purpose Some articles have focused on the effectiveness of the Pavlik harness treatment for unstable and dislocated hips, yet data on monitoring its effectiveness with the acetabular index remains elusive. Therefore, this study aimed to assess Pavlik harness effectiveness in infants ≤6 months diagnosed with grade I developmental dysplasia of the hip using acetabular index improvement and identify the possible predictors of successful Pavlik harness treatment. Methods A retrospective review of infants with grade I acetabular dysplasia treated with a Pavlik harness and monitored with anteroposterior pelvis X-rays at presentation and follow-up. Successful treatment was defined as achieving an acetabular index <30°. Results A total of 231 infants with acetabular dysplasia were treated with a Pavlik harness. A successful outcome was achieved in 135 infants (58.4%). Younger age, lower initial acetabular index, and patients with unilateral developmental dysplasia of the hip were significant predictors of a successful outcome. An age of 4.5 months or older was found to be the threshold for an unsuccessful result following Pavlik harness treatment, with a sensitivity of 65.2% and specificity of 57.3%. An initial acetabular index of 35.5° was found to be the threshold for an unsuccessful result, with a sensitivity of 83.7% and specificity of 61.5%. Conclusion Pavlik Harness's success in correcting the acetabular index in acetabular dysplasia patients was related to unilateral cases, a younger age at presentation, and a lower initial acetabular index. The thresholds for unsuccessful treatment were an age of 4.5 months or greater and an acetabular index of 35.5° or higher.
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Affiliation(s)
- Mohamad Samih Yasin
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Joud Al Karmi
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | | | | | - Mohammad A Alshrouf
- Medical Internship, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Ahmad Abu Halaweh
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Hamdan
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Omar Samarah
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
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Sadeghian SM, Arthurs OJ, Li X, Lewis CL, Shefelbine SJ. Neonatal Hip Loading in Developmental Dysplasia: Finite Element Simulation of Proximal Femur Growth and Treatment. HSS J 2023; 19:418-427. [PMID: 37937091 PMCID: PMC10626923 DOI: 10.1177/15563316231193426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 06/16/2023] [Indexed: 11/09/2023]
Abstract
Background Abnormal prenatal hip joint loading can lead to compromised hip joint function. Early intervention is crucial for favorable outcomes. Purpose This study investigates the impact of treatment timing (initiation and duration) on cartilage growth and ossification in the proximal femur of infants with developmental dysplasia of the hip, a condition affecting newborns. Methods We used a mechanobiological model to simulate proximal femur growth during treatment durations of 3 months, 6 months, and a late-start treatment. Results The findings indicate that the timing of treatment initiation is crucial, while a longer treatment duration does not contribute to improved morphological development of the hip joint. Conclusions Mechanobiological models of growth can be used to develop treatments and therapies that correct loading conditions. Growing bone is particularly sensitive to loading conditions, and altered loading during growth can affect bone shape and functionality.
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Affiliation(s)
- S Mahsa Sadeghian
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Xinshan Li
- Department of Mechanical Engineering, Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - Cara L Lewis
- Department of Physical Therapy, College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Sandra J Shefelbine
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
- Department of Bioengineering, Northeastern University, Boston, MA, USA
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Abdulla N, Ashoor M, Heinz N, Alexopoulos V, Majid I, Morakis E, Khamis AH, Alshryda S. Prognostic factors for failed Pavlik harness treatment in infants with developmental dysplasia of the hip: a retrospective cohort study. Int Orthop 2023; 47:2337-2345. [PMID: 37170027 DOI: 10.1007/s00264-023-05829-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Pavlik harness treatment is the most common treatment in newborns diagnosed with developmental dysplasia of the hip (DDH). The success rates and predictors for failure have been debated over the last decade. In this study, we explored our treatment failure rate and potential prognostic factors that could predict the failure of Pavlik harness (PH) treatment in patients with DDH. METHODS Two hundred and sixty-five patients were treated with PH based on the Graf hip types of classification. Age, gender, first born status, family history, foot deformity, plagiocephaly, breech presentation, hip abduction, hip stability, Graf hip type, Galeazzi sign, bilateralism, and femoral nerve palsy were tested as predictors for failure in multivariate logistic regression mode. Success and failure were determined by the normalization of the hip based on the Graf hip classification. RESULTS The failure rate of patients treated with Pavlik harness was 16.6% which is within the reported range of failure rate. The mean age of patients who were successfully treated was 6.73 weeks in comparison to 8.84 weeks for those who failed. Age, plagiocephaly, hip instability, Graf classification, and the development of femoral nerve palsy were found to be predictors for failure of PH treatment upon univariate analysis only. However, only the presence of Galeazzi sign, hip instability, high grades of Graf hip classification, and the development of femoral nerve palsy proved to be independent predictors for failed PH treatment upon multivariate logistic regression analysis. CONCLUSIONS Pavlik harness treatment is a successful treatment with an average success of 83.4%. Several independent predictors for failure of PH treatment have been identified. These include a positive Galeazzi sign, a frankly dislocated hip, Graf types III and IV, and the development of femoral nerve palsy.
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Affiliation(s)
- Nada Abdulla
- Medical School, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates
| | - Maryam Ashoor
- Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | | | | | - Ibrar Majid
- Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | | | - Amar Hassan Khamis
- Medical School, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates
| | - Sattar Alshryda
- Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates.
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8
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ghanem I, Karam G, Ghanem D, Saliba I. Femoral nerve palsy during Pavlik harness treatment for developmental dysplasia of the hip is not an indication for harness abandonment. J Child Orthop 2023; 17:205-211. [PMID: 37288053 PMCID: PMC10242367 DOI: 10.1177/18632521231172986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/13/2023] [Indexed: 06/09/2023] Open
Abstract
Objectives The aim of this study was to report the incidence of femoral nerve palsy in developmental dysplasia of the hip children treated with Pavlik harness, to identify any possible associated risk factors, and to evaluate its outcome without any specific strap release. Methods A retrospective chart review was conducted on all cases of femoral nerve palsy in a consecutive series of children who underwent Pavlik harness treatment for developmental dysplasia of the hip. In unilateral cases, the developmental dysplasia of the hip was compared to the contralateral side. All hips with femoral nerve palsy were compared to the remaining hips of the series and any possible risk factor for paralysis was recorded. Results In total, 53 cases of femoral nerve palsy of various severity were identified from a group of 473 children with 527 hips treated for developmental dysplasia of the hip at an average age of 3.9 months. However, 93% occurred during the first 2 weeks of treatment. Femoral nerve palsy was more common in older and larger children with the most severe Tonnis type, and a hip flexion angle in the harness above 90° (p < 0.03 for all). All of them resolved spontaneously before completion of treatment without any specific measures. We found no correlation between the presence of femoral nerve palsy or the time taken for spontaneous resolution and treatment failure using the harness. Conclusion Femoral nerve palsy is most observed with higher Tonnis types and high hip flexion angles in the harness, but its presence by itself is not predictive of treatment failure. It resolves spontaneously before completion of treatment and does not require any strap release or harness discontinuation. Level of evidence Level III.
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Affiliation(s)
- Ismat Ghanem
- Department of Orthopedic Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Geoffrey Karam
- Department of Orthopedic Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Diane Ghanem
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ibrahim Saliba
- Department of Orthopedic Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Moya-Angeler J, Jiménez-Soto C, Maestre-Cano D, de la Torre-Conde C, Sánchez-Jimenez RM, Serrano-García C, Alcaraz-Saura M, García-Paños JP, Salcedo-Cánovas C, Forriol F, León-Muñoz VJ. Early Identification and Treatment of Trochlear Knee Dysplasia. J Pers Med 2023; 13:jpm13050796. [PMID: 37240966 DOI: 10.3390/jpm13050796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
A shallow sulcus characterizes trochlear dysplasia (TD) of the femoral trochlea, which can lead to chronic pain or instability of the patellofemoral joint. Breech presentation at birth has been identified as a risk factor for developing this condition, which an ultrasound can identify early. Early treatment could be considered at this stage, given the potential for remodelling in these skeletally immature patients. Newborns with breech presentation at birth who meet the inclusion criteria will be enrolled and randomised in equal proportions between treatment with the Pavlik harness and observation. The primary objective is to determine the difference in the means of the sulcus angle between the two treatment arms at two months. Ours is the first study protocol to evaluate an early non-invasive treatment for TD in the newborn with breech presentation at birth using a Pavlik harness. We hypothesised that trochlear dysplasia could be reverted when identified and treated early in life with a simple harness, as it is done with developmental dysplasia of the hip.
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Affiliation(s)
- Joaquin Moya-Angeler
- Department of Orthopedic Surgery, Hospital Universitario Reina Sofia, 30003 Murcia, Spain
- Instituto de Cirugía Avanzada de Rodilla, 30005 Murcia, Spain
| | | | - Domingo Maestre-Cano
- Department of Orthopedic Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | | | - Regina M Sánchez-Jimenez
- Department of Pediatric Radiology, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Cristina Serrano-García
- Department of Pediatric Radiology, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Miguel Alcaraz-Saura
- Department of Pediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Juan Pedro García-Paños
- Department of Orthopedic Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - César Salcedo-Cánovas
- Department of Orthopedic Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | | | - Vicente J León-Muñoz
- Department of Orthopedic Surgery, Hospital Universitario Reina Sofia, 30003 Murcia, Spain
- Instituto de Cirugía Avanzada de Rodilla, 30005 Murcia, Spain
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bakti K, Lankinen V, Helminen M, Välipakka J, Laivuori H, Hyvärinen A. Clinical and sonographic improvement of developmental dysplasia of the hip: analysis of 948 patients. J Orthop Surg Res 2022; 17:538. [PMID: 36510263 PMCID: PMC9743506 DOI: 10.1186/s13018-022-03432-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Developmental dysplasia of the hip is a common condition, which varies in severity. Abduction treatment is widely used to correct the development of the hips, but mild forms of DDH can also recover spontaneously. The purpose of this study was to evaluate factors affecting the rate of improvement of developmental dysplasia of the hip, and evaluate any risk factors slowing the process. MATERIAL AND METHODS The study population consisted of patients diagnosed with DDH in Tampere University hospital in the years 1998-2018. Data were retrospectively collected, and associations between clinical variables and rate of improvement were analyzed. Alpha angles were assessed monthly, and associations between risk factors and improvement of alpha angles were studied. A total of 948 patients were included in the analysis. RESULTS More severe first status of the hips was associated with faster improvement in dynamic ultrasound compared to milder DDH in univariate design in first 3 months of age; in the multivariable design, Ortolani positivity was conversely associated with lower alpha angles in 1-month follow-up. Immediate abduction treatment was associated with faster recovery rate compared to delayed abduction or watchful waiting. Female sex and positive family history were associated with slower rate of improvement and lower alpha angles. In multivariable design, female sex, positive family history and treatment strategy remained statistically significant as initiation time of the treatment explained the first found association of clinical hip status and the recovery rate after 2 months of age. CONCLUSION Female sex and positive family history might be independent risk factors for slower recovery in DDH before 6 months of age. These children might need special attention in their follow-up plans and abduction treatment.
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Affiliation(s)
- Karim Bakti
- grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Vilma Lankinen
- grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland ,grid.410552.70000 0004 0628 215XDepartment of Pediatric Surgery, Turku University Hospital, Savitehtaankatu 5, 20520 Turku, Finland
| | - Mika Helminen
- grid.502801.e0000 0001 2314 6254Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland ,grid.412330.70000 0004 0628 2985Tays Research Services, Tampere University Hospital, Tampere, Finland
| | | | - Hannele Laivuori
- grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland ,grid.502801.e0000 0001 2314 6254Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland ,grid.412330.70000 0004 0628 2985Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland ,grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Medical and Clinical Genetics, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Anna Hyvärinen
- grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland ,grid.412330.70000 0004 0628 2985Tays Research Services, Tampere University Hospital, Tampere, Finland ,Department of Surgery, Mehiläinen Länsi-Pohja Oy, Kemi, Finland ,grid.412326.00000 0004 4685 4917Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, Oulu, Finland ,grid.10858.340000 0001 0941 4873Clinical Medicine Research Unit, Medical Research Center, University of Oulu, Oulu, Finland
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Shi M, Ban Y, Luan Q, Guo L, Wang Y, Li T, Zhao Q, Pan X, Li X, Teng J. Failure to achieve reduction on developmental dysplasia of hip: an ultrasound evaluation. Acta Radiol 2022; 64:1490-1499. [PMID: 36120851 DOI: 10.1177/02841851221124461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ultrasound examination of the medial side of the hip joint has been rarely used to evaluate the status of developmental dysplasia of the hip (DDH) in Pavlik harness treatment according to the literature. PURPOSE To analyze the effects of cartilaginous acetabulum, hip joint labrum, and acetabular tissue on the reduction of DDH. MATERIAL AND METHODS A total of 50 cases (100 hips) were detected by the Graf method with a high-frequency linear transducer (L 5-12), and there were 59 dislocated hips and 41 non-dislocated hips. Patients were treated with a Pavlik harness. Ultrasound examination of the medial side of the hip joint was performed for follow-up. The hip joints were divided into three groups: the non-dislocated group; the reducible group; and the non-reducible group. RESULTS The success rate of reduction was significantly higher when the acetabulum cartilage was located on the cephalic side (chi-square = 28.12, P < 0.001). The success rate was also significantly higher when the hip joint labrum was located on the cephalic side (chi-square = 17.21, P < 0.001). Type III and D had a higher success rate of reduction than type IV (P < 0.001). The pairwise comparison of the measurements of acetabular tissue between the non-dislocated group, the reducible group, and the non-reducible group showed statistical differences (P < 0.001). CONCLUSION The present study confirmed that the location of acetabulum cartilage and hip joint labrum affected the outcome of treatment. The degree of dislocation and the amount of acetabular tissue were correlated with the success rate of treatment.
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Affiliation(s)
- Miao Shi
- Department of Ultrasound, 426111Liaocheng People's Hospital, Liaocheng, Shandong, PR China
| | - Yongguang Ban
- Department of Ultrasound, 34708Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Qinhua Luan
- Department of Ultrasound, 34708Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Lingfei Guo
- Department of Ultrasound, 34708Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Yanzhou Wang
- Department of Pediatric Surgery, 34708Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Tianyou Li
- Department of Pediatric Surgery, 34708Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Qinghua Zhao
- Department of Ultrasound, 426111Liaocheng People's Hospital, Liaocheng, Shandong, PR China
| | - Xiaojie Pan
- Department of Ultrasound, 426111Liaocheng People's Hospital, Liaocheng, Shandong, PR China
| | - Xin Li
- Department of Ultrasound, 426111Liaocheng People's Hospital, Liaocheng, Shandong, PR China
| | - Jianbo Teng
- Department of Ultrasound, 34708Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, PR China
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Behman AL, Bradley CS, Maddock CL, Sharma S, Kelley SP. Testing of an Ultrasound-Limited Imaging Protocol for Pavlik harness Supervision (TULIPPS) in developmental dysplasia of the hip: a randomized controlled trial. Bone Joint J 2022; 104-B:1081-1088. [PMID: 36047018 DOI: 10.1302/0301-620x.104b9.bjj-2022-0350.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS There is no consensus regarding optimum timing and frequency of ultrasound (US) for monitoring response to Pavlik harness (PH) treatment in developmental dysplasia of the hip (DDH). The purpose of our study was to determine if a limited-frequency hip US assessment had an adverse effect on treatment outcomes compared to traditional comprehensive US monitoring. METHODS This study was a single-centre noninferiority randomized controlled trial. Infants aged under six months whose hips were reduced and centred in the harness at initiation of treatment (stable dysplastic or subluxable), or initially decentred (subluxated or dislocated) but reduced and centred within four weeks of PH treatment, were randomized to our current standard US monitoring protocol (every clinic visit) or to a limited-frequency US protocol (US only at end of treatment). Groups were compared based on α angle and femoral head coverage at the end of PH treatment, acetabular indices, and International Hip Dysplasia Institute (IHDI) grade on one-year follow-up radiographs. RESULTS Overall, 100 patients were included; 42 patients completed the standard protocol (SP) and 40 completed the limited protocol (LP). There was no significant difference in mean right α angle at the end of treatment (SP 70.0° (SD 3.2°) ; LP 68.7° (SD 2.9°); p = 0.033), nor on the left (SP 69.0° (SD 3.5°); LP 68.1° (SD 3.3°); p = 0.128). There was no significant difference in mean right acetabular index at follow-up (SP 23.1° (SD 4.3°); LP 22.0° (SD 4.1°); p = 0.129), nor on the left (SP 23.3° (SD 4.2°); LP 22.8° (SD 3.9°); p = 0.284). All hips had femoral head coverage of > 50% at end of treatment, and all were IHDI grade 1 at follow-up. In addition, the LP group underwent a 60% reduction in US use once stable. CONCLUSION Our study supports reducing the frequency of US assessment during PH treatment of DDH once a hip is reduced and centred.Cite this article: Bone Joint J 2022;104-B(9):1081-1088.
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Affiliation(s)
- Amy L Behman
- Department of Surgery, University of Toronto, Toronto, Canada.,Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Catharine S Bradley
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Connor L Maddock
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Smriti Sharma
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Simon P Kelley
- Department of Surgery, University of Toronto, Toronto, Canada.,Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
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Liu Y, Kan L, Sun J, Zhang Y. Impact of Failed Pavlik Harness Treatment on the Outcomes Following Closed or Open Reduction in Developmental Dysplasia of the Hip. Indian J Orthop 2022; 56:1634-1639. [PMID: 36052383 PMCID: PMC9385939 DOI: 10.1007/s43465-022-00680-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate the impact of failed Pavlik harness (PH) treatment on the outcomes following closed reduction (CR) or open reduction (OR) in developmental dysplasia of the hip (DDH). METHODS Ninety-three DDH patients treated with CR or OR were enrolled. One group of which received previous PH treatment (F group) and the other (L group) not. The clinical outcomes were evaluated according to McKay's criteria. Radiographs were evaluated for acetabular index (AI) and the degree of dislocation of the hips. RESULTS A higher rate of CR was found in F group (P = 0.034). Before CR/OR, the mean AI in F group was significantly lower than that in L group (P = 0.000), while at the last follow-up, the AIs in both groups were all improved. In F group, there were 7 (16.67%), 18 (42.86%) and 17 (40.48%) hips were classified as Graf type II, III and IV pathologic changes, respectively, when PH treatment started, while the corresponding data were 17 (40.48%), 17 (40.48%) and 8 (19.05%) after PH treatment (P = 0.024). At the last follow-up, no significant difference was found concerning the complications between the two groups (P > 0.05). CONCLUSIONS PH treatment, even if failed, may have the ability of accelerating the development of the acetabulum and increasing the rate of successful CR. Thus we advocate a trial of PH treatment for all DDH patients less than 6 months of age. Meanwhile, a close monitoring by dynamic ultrasonography is required due to the risk of AVN.
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Affiliation(s)
- Yong Liu
- grid.186775.a0000 0000 9490 772XDepartment of Pediatric Orthopedic, The Affiliated Provincial Pediatric Hospital of Anhui Medical University, No 39, Wangjiang Road, Hefei City, China
| | - Lisheng Kan
- No 91126 Military Hospital of Chinese PLA, No 116, Youyi Road, Lvshunkou District, Dalian City, China
| | - Jun Sun
- grid.186775.a0000 0000 9490 772XDepartment of Pediatric Orthopedic, The Affiliated Provincial Pediatric Hospital of Anhui Medical University, No 39, Wangjiang Road, Hefei City, China
| | - Yapeng Zhang
- grid.186775.a0000 0000 9490 772XDepartment of Pediatric Orthopedic, The Affiliated Provincial Pediatric Hospital of Anhui Medical University, No 39, Wangjiang Road, Hefei City, China
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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) 2022; 9:children9050752. [PMID: 35626929 PMCID: PMC9139830 DOI: 10.3390/children9050752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Aims To determine the likelihood of achieving a successful closed reduction (CR) of a dislocated hip in developmental dysplasia of the hip (DDH) after failed Pavlik harness treatment We report the rate of avascular necrosis (AVN) and the need for further surgical procedures. Methods Data was obtained from the Northern Ireland DDH database. All children who underwent an attempted closed reduction between 2011 and 2016 were identified. Children with a dislocated hip that failed Pavlik harness treatment were included in the study. Successful closed reduction was defined as a hip that reduced in theatre and remained reduced. Most recent imaging was assessed for the presence of AVN using the Kalamchi and MacEwen classification. Results There were 644 dislocated hips in 543 patients initially treated in Pavlik harness. In all, 67 hips failed Pavlik harness treatment and proceeded to arthrogram (CR) under general anaesthetic at an average age of 180 days. The number of hips that were deemed reduced in theatre was 46 of the 67 (69%). A total of 11 hips re-dislocated and underwent open reduction, giving a true successful CR rate of 52%. For the total cohort of 67 hips that went to theatre for arthrogram and attempted CR, five (7%) developed clinically significant AVN at an average follow-up of four years and one month, while none of the 35 hips whose reduction was truly successful developed clinically significant AVN. Conclusion The likelihood of a successful closed reduction of a dislocated hip in the Northern Ireland population, which has failed Pavlik harness treatment, is 52% with a clinically significant AVN rate of 7%. As such, we continue to advocate closed reduction under general anaesthetic for the hip that has failed Pavlik harness. Cite this article: Bone Jt Open 2021;2(8):594–598.
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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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Xu GW, Yang YC, Xu ZH, Liu YL. Ultrasound features predicting the 3-week outcome of Pavlik harness treatment for developmental hip dysplasia. Ann Palliat Med 2020; 9:1020-1029. [PMID: 32434356 DOI: 10.21037/apm-20-889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/28/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The treatment protocol for children with developmental dysplasia of the hip (DDH) is routinely adjusted by assessing the hip reduction after 3 weeks of Pavlik harness treatment. However, there is a high risk of failure and complications in the treatment adjustment. The aim of this study was to explore the value of ultrasound features in predicting the treatment outcome of Pavlik harness after 3 weeks in DDH children. METHODS A total of 215 DDH children were recruited and the demographics and the changes of ultrasound features [α and β angle and femoral head coverage (FHC)] during the Pavlik harness treatment were recorded. The children were divided into the success group and the failure group according to the reduction outcome after 3 weeks. Univariate and multivariate analyses were performed to analyze the independent predictors for the treatment outcome. Repeated-measures analysis of variance was used to compare the changes of ultrasound features between the two groups during the treatment. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive accuracy of the ultrasound features. RESULTS Graf type III (P=0.036), bilateral dislocation (P=0.031), and age at diagnosis (P=0.021) were associated with an increased risk of Pavlik harness failure in the multivariate analysis. The changes in α and β angle and FHC were generally greater in the success group than in the failure group. The α angle and FHC were larger in the success group, while the β angle was larger in the failure group (P<0.05). Each ultrasound parameter (α and β angle and FHC) alone could not accurately predict the treatment outcome within 3 weeks. However, the combined ultrasonic features at the second week could accurately predict the outcome of Pavlik harness treatment after the third week. The combination of the ultrasound features at the first week and the influencing factors (Graf classification, age at diagnosis, and side of pathology) could accurately predict the outcome at the first week [area under curve (AUC) =0.931, sensitivity =82.14%, specificity =97.86%]. CONCLUSIONS The combined model of ultrasonic features at the second week could accurately predict the reduction outcome of Pavlik harness after the third week. The combined model including independent predictors and ultrasonic features could accurately predict the reduction outcome at the first week.
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Affiliation(s)
- Guang-Wei Xu
- Department of Pediatric Orthopedics, Ningbo Women & Children's Hospital, Ningbo 315012, China
| | - Yan-Cai Yang
- Department of Pediatric Orthopedics, Ningbo Women & Children's Hospital, Ningbo 315012, China.
| | - Zhen-Hua Xu
- Department of Pediatric Orthopedics, Ningbo Women & Children's Hospital, Ningbo 315012, China
| | - Yun-Long Liu
- Department of Pediatric Orthopedics, Ningbo Women & Children's Hospital, Ningbo 315012, China
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Abstract
PURPOSE To understand the variation in the management of hip dysplasia identified from the United Kingdom neonatal selective screening programme. METHODS Having been designed and tested by the research committee of the British Society for Children's Orthopaedic Surgery (BSCOS), a nationwide online survey was conducted of BSCOS members to ascertain their treatment strategies for neonatal hip dysplasia. RESULTS There were 111 responses (60% of members), which illustrated wide variation in care. In all, 91 (over 80%) of respondents treat more than ten cases per year, yet only 61 (55%) work to an agreed protocol. A total of 90 (81%) use the Graf classification and 103 (93%) use the Pavlik harness initially. Consensus is lacking in key areas including duration of harness use, hours per day, clothing and weaning. Importantly, notable differences of opinion even exist regarding which hip pathologies need treatment. CONCLUSION This study quantifies the wide variation in many key elements of the initial treatment of neonatal hip dysplasia in the United Kingdom. This variation appears unnecessary and unacceptable as the Getting It Right First Time programme seeks to standardize care pathways. The charitable sector has called for consensus to mitigate parental anxiety, and it has been suggested that this could allow better integration of hip dysplasia into national screening pathways. Standardized care benefits patients and represents the platform from which we can begin understanding effectiveness and optimizing outcomes. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
| | - Daniel C. Perry
- Alder Hey Children’s Hospital, Liverpool, UK,Correspondence should be sent to Daniel C. Perry, Institute in the Park, Alder Hey Children’s Hospital, Liverpool, L12 2AP, UK. E-mail:
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Abstract
PURPOSE OF THE STUDY Outpatient treatment of hip dysplasia in newborns has excellent results. A combination of general screening with early treatment with a functional abduction device works well. Treatment with the Frejka pillow and the Pavlik harness is frequently used in our region. The aim of the study is to compare efficiency and treatment duration, related to the brace used, and to prove that the choice of an abduction device implies parental compliance with the treatment protocol. MATERIALS AND METHODS Data of 286 treated children were analyzed. The diagnosis was made in the first weeks of life by clinical and sonographic examinations during general screening. The choice of treatment device was expert dependent and was involved by many variables. The experience, type of clinical finding and sonographic pathology according to Graf, availability of a treating facility, and the potential cooperation of individual parents were major parameters. The Frejka pillow was used to treat 145 children and the Pavlik harness was used in 137 children. The treatment duration and percentage of infants lost from follow-up in relation to the device used was documented. RESULTS The success rate of outpatient treatment was 98.6%. In six patients, the type of device had to be changed during the treatment period. Physiological sonographic findings were achieved in all hips by the end of the treatment. The Frejka pillow was used as the preferred device in milder stable dysplastic hips, while unstable and decentered hips were treated more frequently with the Pavlik harness. Treatment lasted, on average, 95 days and 119 days in the Frejka and in the Pavlik group, respectively; there was no statistical significance in treatment duration of comparable sonographic pathologies. We observed statistically greater parental non-compliance with the treatment protocol in the Pavlik harness group (p = 0.0279; OR 2.7; 95% CI 1.07; 8.5). CONCLUSIONS Neither of the abduction devices was inferior with regard to treatment efficiency. We found that parental cooperation was an important factor during screening and treatment. The treatment decision and the choice of the brace must be made with full consent of the parents, keeping in mind that comfort during the nursing care may have a significant influence on compliance with the treatment protocol.
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Affiliation(s)
- Michal Zídka
- Department of Orthopaedics, CLPA-Mediterra, Sokolovská 304, 190 61, Prague 9, Czech Republic. .,Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic.
| | - Valér Džupa
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Neal D, Beckwith T, Hines A, Lee WC, Kilinc BE, Jo C, Kim H. Comparison of Pavlik Harness treatment regimens for reduced but dislocatable (Barlow positive) hips in infantile DDH. J Orthop 2019; 16:440-444. [PMID: 31516214 DOI: 10.1016/j.jor.2019.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/30/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Although the Pavlik Harness (PH) is the most utilized treatment for developmental dysplasia of the hip (DDH), the ideal treatment protocol (frequency of clinic visits in the first month and daily wear duration) for Barlow + hips (reduced but dislocatable) has yet to be defined. Methods This study compared DDH patients with Barlow hips who were treated with 23 vs 24 h per day PH wear and weekly vs every other week visits. Clinical success was defined as a stable hip that did not require closed or open reduction, or the use of an abduction orthosis prior to achieving clinical stability. Radiographic success was based on the acetabular index at 2-year follow up. Results Sixty-five patients (75 hips/58 females) with Barlow hips had a mean age of presentation of 15 ± 12 days (range 4-70) and mean follow-up of 33 ± 17 months (range 6-90). There was no difference in clinical or radiographic success rate between 23 h vs 24 h wear groups (p > 0.99 both) or the Frequently vs Infrequent visit groups (p = 0.49 both). Overall clinical success rate was 97% (73/75 hips) and radiographic success rate at 2 years was 97% (58/60 hips). Conclusion A strict, weekly clinic visit and 24-h PH regimen may not be necessary to obtain good clinical and radiographic outcomes in infants presenting <6 months of age with Barlow positive hips. Level of evidence Therapeutic, Level III.
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Affiliation(s)
- David Neal
- John Peter Smith Hospital, Fort Worth, TX, USA
| | - Terri Beckwith
- Texas Scottish Rite Hospital for Children, Dallas, TX, USA
| | - Adam Hines
- Irwin Army Community Hospital, Fort Riley, KS, USA
| | - Wei Chun Lee
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Bekir Eray Kilinc
- Health Science University, Fatih Sultan Mehmet Training and Research Hospital, Orthopaedics, Istanbul, Turkey
| | - ChanHee Jo
- Texas Scottish Rite Hospital for Children, Dallas, TX, USA
| | - Harry Kim
- Texas Scottish Rite Hospital for Children, Dallas, TX, USA
- Orthopedic Surgery Department at UT Southwestern Medical Center, Dallas, TX, USA
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Cook KA, Schmitt M, Ingram M, Larson JE, Burgess J, Janicki JA. Pavlik Harness initiation on Barlow positive hips: Can we wait? J Orthop 2019; 16:378-81. [PMID: 31065214 DOI: 10.1016/j.jor.2019.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/05/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022] Open
Abstract
We investigated if infants with a Barlow positive hip(s) have natural hip stabilization and can thus avoid Pavlik Harness (PH) treatment. We conducted a chart review for infants who presented within two weeks of life, had a Barlow positive hip, and were deferred treatment. Of the thirty infants, eighteen were treated with PH at 4-6 weeks or 12 weeks due to persistent dysplasia. Twelve infants avoided PH entirely. There were zero cases of PH failure. Parents can be counseled that deferring treatment until at least 4-6 weeks of age might avoid treatment altogether without an increased risk of harness failure.
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Vafaeian B, Adeeb S, El-Rich M, Dulai SK, Jaremko JL. Prediction of mechanical behavior of cartilaginous infant hips in pavlik harness: A subject-specific simulation study on normal and dysplastic hips. J Orthop Res 2019; 37:655-664. [PMID: 30604892 DOI: 10.1002/jor.24213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 12/11/2018] [Indexed: 02/04/2023]
Abstract
In dysplastic infant hips undergoing abduction harness treatment, cartilage contact pressure is believed to have a role in therapeutic cartilage remodeling and also in the complication of femoral head avascular necrosis. To improve our understanding of the role of contact pressure in the remodeling and the complication, we modeled cartilage contact pressure in cartilaginous infant hips undergoing Pavlik harness treatment. In subject-specific finite element modeling, we simulated contact pressure of normal and dysplastic hips in Pavlik harness at 90° flexion and gravity-induced abduction angles of 40°, 60° and 80°. We demonstrated that morphologies of acetabulum and femoral head both affected contact pressure distributions. The simulations showed that in Pavlik harness, contact pressure was mainly distributed along anterior and posterior acetabulum, leaving the acetabular roof only lightly loaded (normal hip) or unloaded (dysplastic hip). From a mechanobiological perspective, these conditions may contribute to therapeutic remodeling of the joint in Pavlik harness. Furthermore, contact pressure increased with the angle of abduction, until at the extreme abduction angle (80°), the lateral femoral head also contacted the posterior acetabular edge. Contact pressure in this area could contribute to femoral head avascular necrosis by reducing flow in femoral head blood vessels. The contact pressure we simulated can plausibly account for both the therapeutic effects and main adverse effect of abduction harness treatment for developmental dysplasia of the hip. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Behzad Vafaeian
- Department of Civil and Environmental Engineering, University of Alberta, 7-203 Donadeo Innovation Centre for Engineering, 9211 - 116 Street, Edmonton, Alberta, T6G 1H9, Canada
| | - Samer Adeeb
- Department of Civil and Environmental Engineering, University of Alberta, 7-203 Donadeo Innovation Centre for Engineering, 9211 - 116 Street, Edmonton, Alberta, T6G 1H9, Canada
| | - Marwan El-Rich
- Department of Mechanical Engineering, Khalifa University, Abu Dhabi, UAE
| | - Sukhdeep K Dulai
- Department of Surgery and Stollery Children's Hospital, University of Alberta, 2C3.46 WMC, 8440 - 112 Street, Edmonton, Alberta, T6G 2B7, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 WMC, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada
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Abstract
PURPOSE The aim of this article is to review the current concepts in the indications, results and failure causes of the treatment of developmental dysplasia of the hip (DDH) with the Pavlik harness. METHODS The reported variables influencing the outcome in the Pavlik harness treatment were analyzed. RESULTS Significant discrepancies about the clinical and radiological outcomes, the rates of failure and complications as well as the variables influencing the treatment outcome occur in the published studies due to the heterogeneity of the data and the differences in the methods used. The overall short-, mid- or long-term success rate of the treatment ranges from 45% to 100% and it is commonly over 75%. The rate of osteonecrosis of the femoral head ranges from 1% to 30%. Age, gender, laterality, radiological or clinical severity of the initial hip pathology and parents' compliance are the commonly reported determinants of failure of the treatment. CONCLUSION The failure in treatment with the Pavlik harness is multifactorial, initial type of hip dysplasia being the most prominent followed by the treatment initiation age. This type of treatment cannot be considered as the best option in Graf IV hips (hip ultrasonography) or highly dislocated hips (plain radiography) and in infants older than three months of age, as the risk of failure and development of complications including osteonecrosis and femoral nerve palsy seem to increase in such circumstances. Large-scale, comparative studies including homogenous data are needed to answer the unsolved questions concerning indications.
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Affiliation(s)
- H. Ömeroglu
- Department of Orthopaedics and Traumatology, TOBB University of Economics and Technology, Faculty of Medicine, Ankara, Turkey, Correspondenceshould be sent to H. Ömerog˘lu, TOBB University of Economics and Technology Hospital, Yasam Caddesi No:5, Sögütözü, Ankara, Turkey. E-mail:
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Salduz A, Demirel M, Akgül T, Bilgili F. An analysis of variables affecting the duration of Pavlik harness treatment: Is it possible to predict the duration of treatment? Prosthet Orthot Int 2018; 42:299-303. [PMID: 29125399 DOI: 10.1177/0309364617740236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pavlik harness is the initial treatment for the infants with developmental dysplasia of the hip who have not yet begun walking. OBJECTIVES The present study evaluates the variables which affect the duration of PH treatment for patients successfully treated. STUDY DESIGN Cross-sectional study. METHODS Pavlik harness was employed for 140 hips of 87 patients with developmental dysplasia of the hip in our institution between 2010 and 2013. In all, 55 hips of 46 patients who were treated successfully with Pavlik harness were included in this study. According to Graf's sonographic classification, 23 hips were Type IIC, 26 were Type IID, and 6 were Type III. The studied variables were (1) alpha angle, (2) age at the start of treatment, (3) laterality, and (4) gender. The variables were compared with the duration of Pavlik harness treatment. RESULTS A highly significant inverse correlation was observed between Pavlik harness application time and alpha angle at the start of the treatment ( r = -0.050; p < 0.001). Bilateral involvement has statistically longer duration, when compared with unilateral involvement ( r = 0.28; p = 0.036). No statistically significant difference was present between duration of treatment and age at the start of Pavlik harness treatment ( r = -0.034; p = 0.804). There was no statistical significance between gender and duration of Pavlik harness ( r = 0.201; p > 0.05). CONCLUSION The duration of treatment was negatively correlated with the initial alpha angle. A change of 1 degree in alpha angle may alter the duration of treatment as 0.89 week calculated by the formula (Application time (Week) = 56.6 - 0.89 × alpha angle). Bilateral involvement may need longer Pavlik harness treatment. Clinical relevance Pavlik harnes generally is the first treatment method for the infants with DDH. This study suggest conclutions about how long time is the Pavlik harness should be kept on the infants? The main indicator is initial alfa angle which is negatively correlated with the duration of treatment.
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Gargan KE, Bradley CS, Maxwell A, Moktar J, Wedge JH, Murnaghan ML, Kelley SP. Education of parents in Pavlik harness application for developmental dysplasia of the hip using a validated simulated learning module. J Child Orthop 2016; 10:289-93. [PMID: 27342120 DOI: 10.1007/s11832-016-0751-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/10/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The Pavlik harness is the most common initial treatment for developmental dysplasia of the hip worldwide. During treatment, parents are required to re-apply the harness at home. Teaching parents how to apply the harness is therefore paramount to success. While simulated learning for medical training is commonplace, it has not yet been trialed in teaching parents how to apply a Pavlik harness. METHODS A group of parents underwent a simulated learning module for Pavlik harness application. Parents were evaluated pre- and post-exposure and at one month after testing. A validated objective structured assessment of technical skill (OSATS) and a global rating scale (GRS) specific to Pavlik harness application were used for evaluation. A control group of parents was also tested at both time points. A clinical expert group was used to determine competency. ANOVA and t tests were used to assess differences between groups and over time. RESULTS Parent scores on the OSATS improved to the level of expert clinicians both immediately post-intervention and at retention testing. However, on the GRS, only half were considered competent due to their inability to achieve the required hip positions. The control group did not improve nor were they considered competent. CONCLUSIONS The use of a simulated learning module improves both the confidence and skill level of parents in the application of the Pavlik harness. However, the challenges parents face in understanding the more detailed subtleties of medical care suggest that they still require an appropriate level of supervision by clinicians to ensure effective treatment.
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Gulati V, Eseonu K, Sayani J, Ismail N, Uzoigwe C, Choudhury MZ, Gulati P, Aqil A, Tibrewal S. Developmental dysplasia of the hip in the newborn: A systematic review. World J Orthop 2013; 4:32-41. [PMID: 23610749 PMCID: PMC3631949 DOI: 10.5312/wjo.v4.i2.32] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 12/29/2012] [Accepted: 01/17/2013] [Indexed: 02/06/2023] Open
Abstract
Developmental dysplasia of the hip (DDH) denotes a wide spectrum of conditions ranging from subtle acetabular dysplasia to irreducible hip dislocations. Clinical diagnostic tests complement ultrasound imaging in allowing diagnosis, classification and monitoring of this condition. Classification systems relate to the alpha and beta angles in addition to the dynamic coverage index (DCI). Screening programmes for DDH show considerable geographic variation; certain risk factors have been identified which necessitate ultrasound assessment of the newborn. The treatment of DDH has undergone significant evolution, but the current gold standard is still the Pavlik harness. Duration of Pavlik harness treatment has been reported to range from 3 to 9.3 mo. The beta angle, DCI and the superior/lateral femoral head displacement can be assessed via ultrasound to estimate the likelihood of success. Success rates of between 7% and 99% have been reported when using the harness to treat DDH. Avascular necrosis remains the most devastating complication of harness usage with a reported rate of between 0% and 28%. Alternative non-surgical treatment methods used for DDH include devices proposed by LeDamany, Frejka, Lorenz and Ortolani. The Rosen splint and Wagner stocking have also been used for DDH treatment. Surgical treatment for DDH comprises open reduction alongside a combination of femoral or pelvic osteotomies. Femoral osteotomies are carried out in cases of excessive anteversion or valgus deformity of the femoral neck. The two principal pelvic osteotomies most commonly performed are the Salter osteotomy and Pemberton acetabuloplasty. Serious surgical complications include epiphyseal damage, sciatic nerve damage and femoral neck fracture.
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Modaressi K, Erschbamer M, Exner GU. Dysplasia of the hip in adolescent patients successfully treated for developmental dysplasia of the hip. J Child Orthop 2011; 5:261-6. [PMID: 22852032 PMCID: PMC3234894 DOI: 10.1007/s11832-011-0356-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 06/10/2011] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The purpose of this study was to analyze whether hips treated for developmental dysplasia of the hip (DDH) during infancy, which were clinically and radiologically fully normalized by walking age, may become dysplastic again during later growth. MATERIALS AND METHODS A total of 150 patients were randomly selected out of a collective of 386 patients treated for DDH at the Department of Orthopaedics at the University of Zurich between 1993 and 2004. Treatment was started at birth and continued for 6 months. All patients had clinically and radiographically normal hips by walking age. The patients did not suffer from other diseases, in particular, neurological or neuromuscular diseases. RESULTS We detected four female subjects among the 150 patients who had been successfully treated for DDH, who had developed dysplastic hips in early adolescence, necessitating acetabular surgery. CONCLUSION The successful treatment of DDH in infancy does not ensure normal hip development; therefore, follow up into maturity may be recommended. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- K. Modaressi
- Department of Orthopaedics, University of Zurich, Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland ,Orthopädie Zentrum Zürich, Seestr. 259, 8039 Zürich, Switzerland
| | - M. Erschbamer
- Department of Orthopaedics, University of Zurich, Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland ,Orthopädie Zentrum Zürich, Seestr. 259, 8039 Zürich, Switzerland
| | - G. U. Exner
- Department of Orthopaedics, University of Zurich, Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland ,Orthopädie Zentrum Zürich, Seestr. 259, 8039 Zürich, Switzerland
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