Reapplication of the Pavlik Harness for Treatment of Developmental Dysplasia of the Hip After Initial Pavlik Harness Failure.
Journal
Journal of pediatric orthopedics
ISSN: 1539-2570
Titre abrégé: J Pediatr Orthop
Pays: United States
ID NLM: 8109053
Informations de publication
Date de publication:
20 Nov 2023
20 Nov 2023
Historique:
medline:
20
11
2023
pubmed:
20
11
2023
entrez:
20
11
2023
Statut:
aheadofprint
Résumé
The Pavlik harness (PH) has been widely used as the standard treatment for infants with developmental dysplasia of the hip (DDH). When the initial application of the PH fails, alternative treatments, such as closed reduction, open reduction, and reapplication of the PH will be considered. Compared with other treatments, reapplication of the PH offers certain advantages, including simplicity and reduced physical, and psychological stress, on both infants and caregivers. This study aims to investigate the effectiveness of reapplying the PH in patients with DDH. This study included patients with DDH (complete dislocation) who were treated by reapplication of PH between 1988 and 2012. Patients who were able to follow-up for more than 5 years were included. We examined the reduction rate and several factors to identify indicators associated with successful reduction during reapplication, including age, sex, side of hip dislocation, and the presence of the Ortolani sign. At the final follow-up, hip development was assessed using the Severin classification, whereas avascular necrosis (AVN) was evaluated using the Kalamchi classification and the Salter criteria. A total of 56 patients (48 females and 8 males) and 57 hips were included in this study. The mean age at first and second application of PH was 4.2 months old (range: 0.12 to 6.4), and 5.8 months old (3.0 to 11.4), respectively. The reduction rate was 49% (28 out of 57 hips). Among the successfully reduced hips, the AVN rate was 3.6% (1 out of 28 hips). The Severin classification revealed 27 hips in class I and 1 hip in class III. Statistical analysis indicated a significantly higher proportion of left hip involvement in the reduction group (85% vs 41%, χ2 test, P < 0.001). Although not statistically significant, the rate of positive Ortolani sign tended to be higher in the reduction group (61% vs 38%, χ2 test, P = 0.06). The reapplication method demonstrated a 49% reduction rate and a low AVN rate of 3.6% in our study. It is worth considering for patients who fail the initial PH treatment, particularly in cases of left-side dislocation and a positive Ortolani sign during the initial application.
Identifiants
pubmed: 37981894
doi: 10.1097/BPO.0000000000002572
pii: 01241398-990000000-00419
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Shipman SA, Helfand M, Moyer VA, et al. Screening for developmental dysplasia of the hip: a systematic literature review for the US Preventive Services Task Force. Pediatrics. 2006;117:e557–e576.
Pavlik A. [Method of functional therapy with strap braces as a principle of conservative therapy of congenital dislocation of the hip in infants]. Z Orthop Ihre Grenzgeb. 1957;89:341–352.
Tibrewal S, Gulati V, Ramachandran M. The Pavlik method: a systematic review of current concepts. J Pediatric Orthop B. 2013;22:516–520.
Kumazawa H, Yoshihashi Y. Long-term results of congenital dislocation of the hip treated with Pavlik harness. Nihon Seikeigeka Gakkai Zasshi. 1991;65:851–861.
Fujioka F, Terayama K, Sugimoto N, et al. Long-term results of congenital dislocation of the hip treated with the Pavlik harness. J Pediatr Orthop. 1995;15:747–752.
Cashman JP, Round J, Taylor G, et al. The natural history of developmental dysplasia of the hip after early supervised treatment in the Pavlik harness. A prospective, longitudinal follow-up. J Bone Joint Surg Br. 2002;84:418–425.
Nakamura J, Kamegaya M, Saisu T, et al. Treatment for developmental dysplasia of the hip using the Pavlik harness. J Bone Joint Surg Br. 2007;89:230–235.
Ohmori T, Endo H, Mitani S, et al. Radiographic prediction of the results of long-term treatment with the Pavlik harness for developmental dislocation of the hip. Acta Med Okayama. 2009;63:123–128.
Narayanan U, Mulpuri K, Sankar W. Reliability of a new radiographic classification for developmental dysplasia of the hip. J Pediatr Orthop. 2015;35:478–484.
Yamamuro T, Chene S. A radiological study on the development of the hip joint in normal infants. JPN Orthop Assoc. 1975;49:421–439.
Severin E. Contribution to the knowledge of congenital dislocation of the hip joint. Late results of closed reduction and arthrographic studies of recent cases. Acta Chir Scand. 1941;63:14–142.
Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1980;62:876–888.
Salter RB, Kostuik J, Dallas S. Avascular necrosis of the femoral head as a complication of treatment for congenital dislocation of the hip in young children: a clinical and experimental investigation. Can J Surg. 1969;12:44–61.
Tsukagoshi Y, Kamegaya M, Kamada H, et al. The correlation between Salter’s criteria for avascular necrosis of the femoral head and Kalamchi’s prognostic classification following the treatment of developmental dysplasia of the hip. Bone Joint J. 2017;99B:1115–20.
Iwasaki K. Management after application of the PH in congenital dislocation of the hip. Arch Orthop Trauma Surg. 1987;106:276–280.
Suzuki S. Ultrasound and the Pavlik harness in CDH. J Bone Joint Surg Br. 1993;75:483–487.
Kamegaya M, Shinohara Y, Shinada Y, et al. Anterior approach in ultrasonic scanning for congenital dislocation of the hip treated in the Pavlik’s harness. J JPN Pediatr Orthop Assoc. 1993;2:510–515.
Malvitz TA, Weinstein SL. Closed reduction for congenital dysplasia of the hip. J Bone Joint Surg Am. 1994;76:1777–1792.
Morcuende JA, Meyer MD, Dolan LA, et al. Long-term outcome after open reduction through an anteromedial approach for congenital dislocation of the hip. J Bone Joint Surg Am. 1997;79:810–817.
Abdulla N, Ashoor M, Heinz N, et al. 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.
Kitoh H, Kawasumi M, Ishiguro N. Predictive factors for unsuccessful treatment of developmental dysplasia of the hip by the PH. J Pediatr Orthop. 2009;29:552–557.
Inoue T, Naito M. Treatment of developmental dysplasia of the hip with the Pavlik harness: factors for predicting unsuccessful reduction. J Pediatr Orthop B. 2001;10:186–191.
Vadillo P, Encinas-Ullan CA, Moraleda L, et al. Results of the Pavlik harness when treating Ortolani-positive hips: predictors of failure and arthrographic findings. J Child Orthop. 2015;9:249–253.
Mubarak SJ, Bialik V. Pavlik: the man and his method. J Pediatr Orthop. 2003;23:342–346.
Ramsey PL, Lasser S, MacEwen GD. Congenital dislocation of the hip: use of the Pavlik harness in the child during the first six months of life. J Bone Joint Surg Am. 1976;58:1000–1004.
Iwasaki K. Treatment of congenital dislocation of the hip by the Pavlik harness. Mechanism of reduction and usage. J of Bone Joint Surg. 1983;65:760–767.
Ardila OJ, Divo EA, Moslehy FA, et al. Mechanics of hip dysplasia reductions in infants using the Pavlik harness: a physics-based computational model. J Biomech. 2013;46:1501–1507.
Jones GT, Schoenecker PL, Dias LS. Developmental hip dysplasia potentiated by inappropriate use of the Pavlik harness. J Pediatr Orthop. 1992;12:722–726.
Fukiage K, Futami T, Ogi Y, et al. Ultrasound-guided gradual reduction using flexion and abduction continuous traction for developmental dysplasia of the hip: a new method of treatment. Bone Joint J. 2015;97-B:405–411.
Terjesen T, Horn J, Gunderson RB. Fifty-year follow-up of late-detected hip dislocation: clinical and radiographic outcomes for seventy-one patients treated with traction to obtain gradual closed reduction. J Bone Joint Surg Am. 2014;28:1–9.
Holman J, Carroll KL, Murray KA, et al. Long-term follow-up of open reduction surgery for developmental dislocation of the hip. J Pediatr Orthop. 2012;32:121–124.
Cove R. Outcome at forty-five years after open reduction and innominate osteotomy for late-presenting developmental dislocation of the hip. J Bone Joint Surg. 2007;91:2772.
Yoshihashi Y, Tanaka T, Hattori T, et al. Overhead traction in the treatment of congenital dislocation of the hip. Clin Orthop Surg. 1991;26:141–147.
Paterson SI, Eltawil NM, Simpson AHRW, et al. Drying of open animal joints in vivo subsequently causes cartilage degeneration. Bone Joint Res. 2016;5:137–144.
Li YQ, Hu W, Xun FX, et al. Risk factors associated with unsatisfactory hip function in children with late-diagnosed developmental dislocation of the hip treated by open reduction. Orthop Traumatol Surg Res. 2020;106:1373–1381.