Comparison of Pavlik Harness treatment regimens for reduced but dislocatable (Barlow positive) hips in infantile DDH

Neal, David C.; Beckwith, Terri; Hines, Adam C.; Lee, Wei Chun; Kılınç, Bekir Eray; Jo, Chan Hee; Kim, Harry K.W.

doi:10.1016/j.jor.2019.06.027

Cited by 8 publications

(6 citation statements)

References 17 publications

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“…Later initiated treatment inevitably leads to delayed improvement. Immediate Pavlik harness treatment in infants with mild DDH (Ortolani negative) is controversial because majority of the infants will improve without treatment, and it seems that it is safe to wait with the initiation of the treatment [ 27 , 28 ]. Our results give new information as it seems that in mild DDH recovery might delay because of the watchful waiting period.…”

Section: Discussionmentioning

confidence: 99%

Clinical and sonographic improvement of developmental dysplasia of the hip: analysis of 948 patients

et al. 2022

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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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Section: Discussionmentioning

confidence: 99%

Clinical and sonographic improvement of developmental dysplasia of the hip: analysis of 948 patients

et al. 2022

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“…Ortolani negative patients with minor instability of the hips form a risk group for delayed recovery, because these patients are often observed in the beginning. Immediate Pavlik harness treatment in infants with Barlow positive hips is controversial because majority of the infants will improve without treatment, and it seems that it is safe to wait the initiation of the treatment (32,33). Our results give new information as it seems that in mild DDH recovery might delay because of the watchful waiting period.…”

Section: Discussionmentioning

confidence: 80%

Clinical and sonographic improvement of developmental dysplasia of the hip: Analysis of 948 patients

Lankinen

Bakti

Helminen

et al. 2022

Preprint

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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 was retrospectively collected and associations between clinical variables and rate of improvement was analyzed. Alpha angles were assessed monthly and associations between risk factors and improvement of alpha angles were studied. Total of 948 patients were included in the analysis. Results More sever 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 six months of age. These children might need special attention in their follow-up plans and abduction treatment.

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“…Clinically, unstable hips have been conventionally diagnosed by provocative maneuvers [9][10][11][12] , which are widely used around the world as screening techniques. However, the reliability of this test is dependent on the skill and experience of the examiner, with iatrogenic effects possible from repeated examinations 22 ; thus, a standardized image analysis method is desired to address this issue.…”

Section: Discussionmentioning

confidence: 99%

“…Provocative maneuvers have been used widely for screening unstable hips [9][10][11][12] . Therapeutic interventions should be performed on the unstable hips of infants under 6 months 13 , whereas infants with stable hips can be observed.…”

Section: Introductionmentioning

confidence: 99%

Explainable AI Models on Radiographic Images Integrated with Clinical Measurements: Prediction for Unstable Hips in Infants

Shimizu,

Enda,

Koyano

et al. 2024

Preprint

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Considering explainability is crucial in medical artificial intelligence, technologies to quantify Grad-CAM heatmaps and perform automatic integration based on domain knowledge remain lacking. Hence, we created an end-to-end model that produced CAM scores on regions of interest (CSoR), a measure of relative CAM activity, and feature importance scores by automatic algorithms for clinical measurement (aaCM) followed by LightGBM. In this multicenter research project, the diagnostic performance of the model was investigated with 813 radiographic hip images in infants at risk of unstable hips, with the ground truth defined by provocative examinations. The results indicated that the accuracy of aaCM was higher than that of specialists, and the model with ad hoc adoption of aaCM outperformed the image-only-based model. Subgroup analyses in positive cases indicated significant differences in CSoR between the unstable and contralateral sides despite containing only binary labels (positive or negative). In conclusion, aaCM reinforces the performance, and CSoR potentially indicates model reliability.

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Comparison of Pavlik Harness treatment regimens for reduced but dislocatable (Barlow positive) hips in infantile DDH

Cited by 8 publications

References 17 publications

Clinical and sonographic improvement of developmental dysplasia of the hip: analysis of 948 patients

Clinical and sonographic improvement of developmental dysplasia of the hip: analysis of 948 patients

Clinical and sonographic improvement of developmental dysplasia of the hip: Analysis of 948 patients

Explainable AI Models on Radiographic Images Integrated with Clinical Measurements: Prediction for Unstable Hips in Infants

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