A Comparison of Pavlik Harness Treatment Regimens for Dislocated But Reducible (Ortolani+) Hips in Infantile Developmental Dysplasia of the Hip

Hines, Adam C.; Neal, David C.; Beckwith, Terri; Jo, Chan Hee; Kim, Harry K.W.

doi:10.1097/bpo.0000000000001052

Cited by 17 publications

(11 citation statements)

References 13 publications

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“…Developmental dysplasia of the hip refers to a spectrum of hip deformities, ranging from mild dysplasia to frank dislocation. In early-presenting infants, a Pavlik harness may solve the problem [1,2]. For those who failed the treatment or the early diagnosis, closed reduction (CR) or open reduction (OR) might be necessary within 24 months of age [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Anterior approach with mini-bikini incision in open reduction in infants with developmental dysplasia of the hip

Wang

Lian

et al. 2020

J Orthop Surg Res

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Purpose: The anterior and medial approaches in open reduction for developmental dysplasia of the hip (DDH) had been widely used. The former could not directly approach the intra-articular interposition, while the latter had been associated with injury to blood vessel and avascular necrosis (AVN) of the femoral head. Meanwhile, the bikini incision had also been mentioned in some studies. The purpose of this study was to introduce a modified anterior approach through a mini-bikini incision and report its short-term outcomes. Methods: Data of DDH patients younger than 2 years at the time of surgery who had received this mini-bikini incision between June 2013 and December 2018 were collected. The surgical technique, operation duration, intraoperative blood loss, and length of incision were recorded in detail. In the latest follow up, the objective measurement of the scar and the subjective feeling towards the scar were collected. X-ray and magnetic resonance imaging (MRI) were performed at the last follow-up, and the incidence of residual dysplasia, redislocation, and femoral head AVN was analyzed. Results: Forty-three cases (49 hips) were included with an averaged follow-up of 43 months. The operation duration was 22 min, and the blood loss was 9.8 ml on average. The length of the scar averaged 2.6 cm. The mean University of North Carolina "4P" scar scale (UNC4P) for the scar was 0.92, and no patients complained numbness. Overall, all the parents were satisfied with the cosmetic appearance. The mean acetabular index (AI) was 27.42°± 6.41°in dislocated hip in the last follow-up. One hip redislocated soon after the operation and was reduced in a closed manner right away. MRI showed improved coverage but still some residual dysplasia that was in accordance with the post-operative recovery nature. Four hips (8%) had signs of AVN in X-ray. Conclusion: Open reduction through the anterior approach with the mini-bikini incision was a safe procedure with comparable outcomes to classical approaches. It would be a complementary approach for DDH patients younger than 2 years old who need an open reduction.

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Section: Introductionmentioning

confidence: 99%

Anterior approach with mini-bikini incision in open reduction in infants with developmental dysplasia of the hip

Wang

Lian

et al. 2020

J Orthop Surg Res

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“…In total, 72% of respondents advise the harness to be worn for 24 hours a day when initiating treatment. Hines et al 8 recently suggested that neither reducing harness wear to 23 hours a day, nor reducing frequency of review, had an adverse effect on treatment success in Ortolani positive hips. Interestingly, of those who advise 23 hours a day, most have been in practice for less than five years, suggesting an awareness of current literature may trump ‘early years’ caution.…”

Section: Discussionmentioning

confidence: 99%

“…Very few comparative studies exist to inform the use of the Pavlik harness, 8,9 so it is unsurprising that there is little consensus among orthopaedic surgeons relating to the duration of use, or the timing and method of cessation. There is frequently discussion related to how many hours per day the harness is worn, if clothing is allowed beneath the harness, when treatment should be ceased and if it is stopped immediately or weaned.…”

Section: Introductionmentioning

confidence: 99%

The treatment of neonatal hip dysplasia with splints in the United Kingdom: Time for consensus?

Westacott

Perry

2020

Journal of Children's Orthopaedics

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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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“…In children that are tolerant and of suitable size, PH application is usually full time with one hour in the day for bathing/hygiene purposes. There is no difference between 23 and 24 h/day harnessing [65]. In children with Ortolani-positive hips, harnesses should not be removed by parents due to the risk of posterior wall erosion and higher failure rates [19].…”

Section: Part-time or Full-time Bracingmentioning

confidence: 99%

Principles of Bracing in the Early Management of Developmental Dysplasia of the Hip

Merchant

Singh

Dala-Ali

et al. 2021

JOIO

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A Comparison of Pavlik Harness Treatment Regimens for Dislocated But Reducible (Ortolani+) Hips in Infantile Developmental Dysplasia of the Hip

Abstract: Level III-therapeutic.

Cited by 17 publications

References 13 publications

Anterior approach with mini-bikini incision in open reduction in infants with developmental dysplasia of the hip

Anterior approach with mini-bikini incision in open reduction in infants with developmental dysplasia of the hip

The treatment of neonatal hip dysplasia with splints in the United Kingdom: Time for consensus?

Principles of Bracing in the Early Management of Developmental Dysplasia of the Hip

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