Staged weaning versus immediate cessation of Pavlik harness treatment for developmental dysplasia of the hip

Westacott, Daniel; Mackay, Nicola; Waton, A; Webb, Matthew L.; Henman, Philip; Cooke, Stephen J.

doi:10.1097/bpb.0000000000000025

Cited by 20 publications

(27 citation statements)

References 17 publications

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“…Six other studies reported the inclusion of a harness weaning protocol, however due to the varied reporting, a more thorough analysis on the effect of a weaning protocol on the development of late dysplasia was not able to be performed. 19 Yes Yes 1.3 6 weeks full time 0.000% 0.00% Walton 17 Yes No 2 11 weeks 0.81% 0.81% Kalamchi 21 Yes Yes 5 7 months 0.700% 0.700% Westacott 18 Yes Yes 2 A: 9.2 weeks B: 7.3 weeks 3.800% 3.80%…”

Section: Resultsmentioning

confidence: 99%

“…Of the identified 6029 hips treated with the Pavlik method in this review, 9.49% of hips were found to have radiographic evidence of late acetabular dysplasia, with 4.14% undergoing additional surgery to address their dysplasia. 5,6,8,[10][11][12][13][14][15][16][17][18][19] We identified that in studies presenting a standardized treatment protocol, the incidence of radiographic acetabular dysplasia dropped significantly to 3.8% as compared with 17.6% in studies that did not report a standard treatment protocol.…”

Section: Discussionmentioning

confidence: 99%

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Late acetabular dysplasia after successful treatment for developmental dysplasia of the hip using the Pavlik method: A systematic literature review

Shaw¹,

Moreland²,

Olszewski³

et al. 2019

Journal of Orthopaedics

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The Pavlik method is the most common method used for treatment of developmental dysplasia of the hip (DDH). Late acetabular dysplasia despite successful treatment, however, has had varied reporting. A systematic review was performed, investigating the long-term outcomes of DDH treated with the Pavlik method. Seventeen studies met inclusionary criteria, including 6029 hips treated with an average of 5.29 years follow-up. Radiographic evidence of late dysplasia was present in 280 hips, with 109 hips requiring additional surgery. A specified treatment algorithm had significantly decreased rates of radiographic dysplasia (3.8% vs 17.6%, p = 0.004). Level of evidence: IV.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Late acetabular dysplasia after successful treatment for developmental dysplasia of the hip using the Pavlik method: A systematic literature review

Shaw¹,

Moreland²,

Olszewski³

et al. 2019

Journal of Orthopaedics

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“…Hip ultrasonography is a useful tool to follow the course of treatment by the Pavlik harness, besides its early diagnostic aids in DDH [20,29]. When a normal hip sonogram is achieved after Pavlik harness treatment, no considerable difference exists between staged and immediate ending of the treatment regarding outcomes and complications [30].…”

Section: Introductionmentioning

confidence: 99%

Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip

Ömeroğlu

Köse

Akceylan

2016

Clinical Orthopaedics &Amp; Related Research

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Background Treatment of developmental dysplasia of the hip (DDH) using the Pavlik harness has been a widely used method in patients between 0 and 6 months of age for many years. However, the factors influencing the success rate of this treatment modality have still not exactly been determined as a result of the limited number of clinical studies with higher level of evidence. Questions/purposes We, therefore, asked whether (1) patient-related variables such as age, gender, and laterality; coexisting risk factors including family history, breech presentation, intrauterine packing, first-born girl, oligohydroamnios, and swaddling; and (2) the severity of hip dysplasia, defined by ultrasonography, are associated with differences in the success rate of Pavlik harness treatment in infants with DDH. Methods Between 2012 and 2014, we treated 153 children (B 6 months of age) with DDH using the Pavlik harness. Hip dysplasia apart from coexisting neuromuscular disorders, congenital abnormalities, or syndromes was our inclusion criteria. Of patients thus treated, 130 (85%) were available for the evaluation of patient-and hip-related variables against the success of Pavlik harness treatment. Mean age of these patients on day of diagnosis and initiation of treatment was 108 days. The diagnostic and followup examinations of the hips were made by ultrasonography using Graf's method. Pavlik harness treatment was initiated in Graf Type IIa-and worse hips and treatment was considered ''successful'' when a Graf Type I hip was achieved. Pavlik harness treatment was successful in 92 (71%) patients (130 of 181 hips [72%]). Results Age was the only patient-related variable influencing the success rate of the treatment; the mean age of children in whom Pavlik harness treatment succeeded (97 ± 38 days; 95% confidence interval [CI], 90-112) was lower than the age of those who failed (135 ± 37 days; 95% CI, 123-147; p \ 0.001). The highest success rate was obtained in children younger than age 3 months (37 of 40 [93%]) and the lowest one older than age 5 months (nine of 24 [37%]) (p \ 0.001). The threshold age value related to an increased risk of failure was found to be 4 months and older, which had a sensitivity of 66% and a specificity of 77% (p \ 0.001). A higher initial a angle was observed in the hips in which the treatment succeeded (53°± 6°; 95% CI, 51°-53°) than in those that failed (47°± 7°; 95% CI, 45°-

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“…Although gold-standard treatment for children younger than six months is abduction splints [ 19 – 22 ], with hip flexion and abduction and knee flexion, the brace is usually provided at hospital discharge. Therefore, we treated the patient with an experimental protocol during hospital stay, in order to optimize hip stability in this period and to avoid the use of Pavlik harness at term age.…”

Section: Discussionmentioning

confidence: 99%

“…Early intervention can provide a better outcome [ 1 , 18 ]. The treatment for children younger than six months is splinting, mainly by the Pavlik harness [ 19 – 22 ], as well as for infants classified as II or higher (Atalar et al, [ 23 ]). Hip flexion and abduction and knee flexion maintain hip motion and result in the gentle reduction of the hip [ 21 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Hip Mobilization at Preterm Age May Accelerate Developmental Dysplasia Recovery

Voos

Drummond

Hasue

2018

Case Reports in Medicine

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Purpose Few studies have described mobilization approaches in developmental dysplasia of the hip (DDH). The present study describes the hip mobilization of a preterm infant (born at 33 6/7 weeks of gestational age) diagnosed with DDH. Design and Methods During the 43-day hospital stay, the infant was seen twice a week (ten sessions, 20 minutes each). All sessions included hip approximation maneuvers, with the hip positioned in abduction, lateral rotation and flexion, and lower limbs passive mobilization, which were taught to the mother. Early intervention with auditory, tactile, visual, and vestibular stimulations was also performed. The infant was assessed with hip ultrasound before and after treatment. Results At 34 2/7 weeks of gestational age, she was classified as Graf IIa (left: alpha: 55°, beta: 68°; right: alpha: 59°, beta: 64°). At 40 5/7 weeks, she was classified as Graf I for left (alpha: 67°; beta: 42°) and right (alpha: 66°; beta: 42°) hips. Practical Implications The intervention seemed to accelerate the acquisition of stability of dysplasic hips in a preterm infant. The outcome supports further investigation of hip approximation maneuvers as part of early stimulation in preterm infants with DDH during hospital stay.

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Staged weaning versus immediate cessation of Pavlik harness treatment for developmental dysplasia of the hip

Cited by 20 publications

References 17 publications

Late acetabular dysplasia after successful treatment for developmental dysplasia of the hip using the Pavlik method: A systematic literature review

Late acetabular dysplasia after successful treatment for developmental dysplasia of the hip using the Pavlik method: A systematic literature review

Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip

Hip Mobilization at Preterm Age May Accelerate Developmental Dysplasia Recovery

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