Graf Type-IV Hips Have a Higher Risk of Residual Acetabular Dysplasia at 1 Year of Age Following Successful Pavlik Harness Treatment for Developmental Hip Dysplasia

PurposeIn this study the course of unstable hips after successful treatment with Fettweis plaster of Paris (POP) is examined. Special focus will be given to age at beginning of treatment and initial hip type.MethodsThe development of 93 unstable hips treated between November 2001 and April 2015 was examined. Inclusion criteria were: 1) unstable hips with successful treatment with Fettweis POP; 2) presence of two pelvic radiographs (12 to 24 months and 24 to 48 months). We analyzed: 1) the initial ultrasound hip type according to Graf; 2) the average age at first and second radiograph; 3) the Tönnis classification: normal findings (< 1 SD), slightly (1 SD to 2 SD) and severely dysplastic hips (> 2 SD).ResultsIn all, there were 14 hips type D, 41 hips type III and 38 hips type IV. Mean age of the first radiograph was 13.9 months and of the second 28.5 months. The first radiograph showed: (< 1 SD): 36, (1 SD to 2 SD): 34, (> 2 SD): 23 hips, the second radiograph: (< 1 SD): 33, (1 SD to 2 SD): 19, (> 2 SD): 30 hips. With subdivision at the start of treatment at age eight or fewer weeks 2/16 hips (12.5%) and with initiation of the treatment more than eight weeks 22/77 (26.0%) deteriorated. During the course between first and second radiograph a total of 35.7% of initial hip type D, 19.5% of type III and 23.7% of type IV deteriorated.ConclusionRadiograph controls after treatment with Fettweis POP show poorer outcome after delaying the start of treatment more than 8 weeks. These findings were independent of the initial ultrasound hip type. Regular radiograph controls of all hip types treated for unstable hips are justified to detect residual dysplasia.Level of evidence:IV

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“…Pavlik harness. [33][34][35] We support the conclusion that regular controls are recommended until cessation of growth.…”

Section: Discussionsupporting

confidence: 67%

Poorer radiological outcome after delayed diagnosis and treatment in human position in Fettweis plaster cast in 93 unstable hip joints type D, III and IV according to Graf

Kubo

Pilge

et al. 2018

Journal of Children's Orthopaedics

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“…This difference may be due to the severity of the dysplasia in type-IV hip, compared with type-II and –III hips, with the normal anatomy of the hip being difficult to restore regardless of the type of hip abduction orthosis used. 26 , 30 , 31 Nevertheless, the success rate of THFS for the treatment of Graf type-IV hips appears to be higher than the rate for PH treatment, as previously reported, although we did not compare the THFS with the PH specifically in our study. By comparison, not all type-IV hips treated using the THFS have poor outcomes.…”

Section: Discussionmentioning

confidence: 50%

“… 36 However, Zhou et al 14 indicated that the relatively high incidence of AVN with PH treatment could be attributed to an over-abduction of the hip due to the non-rigid design of the splint. Moreover, Novais et al 30 reported a non-negligible rate of acetabular dysplasia over a one-year period of follow-up in infants with type-IV DDH who had achieved a successful treatment using the PH. In particular, the incidence of residual dysplasia at the six- and 12-month follow-up was 11.7% and 11.8%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Tübingen hip flexion splint for the treatment of developmental dysplasia of the hip in children younger than six months age: A meta-analysis

Zhi

Xiao

Wan

et al. 2021

Journal of Children's Orthopaedics

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Purpose To investigate the success rate of the Tübingen hip flexion splint (THFS) for the treatment of developmental dysplasia of the hip (DDH), of different severity as per the Graf classification, among infants younger than six months of age. The type and incidence rate of complications associated with THFS treatment were also evaluated. Methods The following databases were searched using keywords and limited for age less than six months: PubMed, Embase, Web of Science, Cochrane Library, and SinoMed, between inception and July 2020. Articles were screened and extracted by two researchers, and the quality of the included literature was evaluated (methodological index for non-randomized studies criteria). R studio 1.3 was used for statistical analysis. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results After screening, eight articles were included in the analysis, contributing 1211 hips (875 patients). The overall success rate of THFS treatment is 91% (95% confidence interval (CI) 0.82 to 0.95). The success rate by Graf type is as follows: type-II, 98% (95% CI 0.94 to 1.00); type-III, 96% (95% CI 0.88 to 1.00); and type-IV, 32% (95% CI 0.18 to 0.47). Complications (24/1211, 2%) included transient femoral nerve palsy (n = 1); avascular necrosis of the femoral head (n = 9) and residual acetabular dysplasia (n = 14). Conclusion THFS treatment is successful for Graf type-II and –III, but low for type-IV, with a low rate of complication. THFS may be an effective treatment option for DDH among infants less than six months of age. However, those with Graf type-IV require close monitoring. Level of Evidence: III

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“…Therefore, it has been shown that early detection of DDHs through a general screening and early treatment are preventive for a large proportion of subsequent extensive hip surgeries [24]. Currently, it is not well understood why a certain percentage of DDH cases that were primarily adequately treated and showed good maturation in sonographic follow-ups have a tendencyindependent of the treatment methodtowards secondary deterioration in radiologic follow-ups at 2 and 5 years [23,25]. It remains a matter of future research whether there is a diagnostic gap after final sonographic control (and impossibility to continue sonography as femoral ossification takes place) and primary radiologic control by a.-p. pelvis X-rays that may not be sensitive enough to diagnose deterioration.…”

Section: Discussionmentioning

confidence: 99%

Mid-term Follow-Up after Closed Reduction in Developmental Dysplastic Hips

et al. 2022

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Purpose Closed reduction and subsequent spica casting is the gold standard for treatment of unstable or dislocated developmental dysplastic hips (DDHs). There are few data on mid-term results after treatment of DDH, especially on closed reduction. Methods Thirty-one consecutive patients with unstable or dislocated hips (n = 36) that were treated by fluoroscopic, contrast agent-supported closed reduction and spica casting were included and evaluated clinically and radiologically 2 and 5 years after treatment. Results After 2 and 5 years, there were no significant differences between healthy and successfully treated hips that were detectable with respect to acetabular coverage (AC) angle, center-edge angle, and clinical stability of the hip. There was a significant difference at the 2-year follow-up between healthy hips and hips that needed to undergo secondary open reduction surgery (n = 4) with respect to the AC angle (p < 0.001). Conclusion Closed reduction in DDHs results in acceptable clinical and radiological results in the mid-term follow-up. It remains unclear why some patients with subsequent sonographically matured hips show secondary deterioration and recurrence of dysplasia.

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Graf Type-IV Hips Have a Higher Risk of Residual Acetabular Dysplasia at 1 Year of Age Following Successful Pavlik Harness Treatment for Developmental Hip Dysplasia

Abstract: Level III-therapeutic study.

Cited by 20 publications

References 24 publications

Poorer radiological outcome after delayed diagnosis and treatment in human position in Fettweis plaster cast in 93 unstable hip joints type D, III and IV according to Graf

Poorer radiological outcome after delayed diagnosis and treatment in human position in Fettweis plaster cast in 93 unstable hip joints type D, III and IV according to Graf

Tübingen hip flexion splint for the treatment of developmental dysplasia of the hip in children younger than six months age: A meta-analysis

Mid-term Follow-Up after Closed Reduction in Developmental Dysplastic Hips

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