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

Shaw, K. Aaron; Moreland, Colleen M.; Olszewski, Dana; Schrader, Tim

doi:10.1016/j.jor.2018.11.001

Cited by 20 publications

(39 citation statements)

References 28 publications

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“…The current study aims to evaluate primary acetabular dysplasia, excluding residual acetabular dysplasia secondary to management with surgery or conservative method, and this is the most significant difference from the earlier studies in the literature (15). Our findings show that abduction orthosis is an effective method in the treatment of patients with acetabular dysplasia.…”

Section: Discussionmentioning

confidence: 85%

“…Acetabular dysplasia could be easily underestimated due to late-onset symptoms or even asymptomatic contrary to hip dislocation, but prevalence and importance are more than predicted. In a systematic review of the literature conducted by Shaw and et al(15), radiographic evidence of late dysplasia was present in 9,49% hips and 4,14% hips requiring additional surgery of 6029 hips treated with the Pavlik method an average of 5.29 years followup. Dornacher et al detected residual dysplasia in 30% of their patients on pelvic X-rays when children started walking even after successful ultrasound-monitored treatment(17).Sarkissian et al showed that 17% of all infants, who had achieved both normal ultrasonographic and clinical examinations at an average of three months, demonstrated radiographic signs of acetabular dysplasia at the age of average six months(18).…”

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confidence: 99%

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Abduction Orthosis in Treatment of Primary Acetabular Dysplasia: Results of Three Years Follow-up

Yüksel¹,

Ünlü²,

Ersan³

et al. 2022

acmr

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Background: Acetabular dysplasia (AD) may appear after six-months-old despite normal previous physical and ultrasonographic examination, and management remains unclear. The purpose of the current study was to evaluate the success of abduction orthosis in the treatment of primary AD patients. Methods:Patients presented with AD between 2010-2017 were retrospectively reviewed. The study included AD patients who had stable hip joints on previous physical examination and Graf type1 on ultrasonography when younger than six months. AD was diagnosed according to the age-related acetabular index (AI) values. Abduction orthoses were applied full-time for five months plus part-time for three months. AI was re-measured at the sixth month, at the end of the first and third year. AI change was compared between dysplastic and nondysplastic hips.Results: It was evaluated 60 hips of 39 patients with AD treated with abduction orthosis at the median age of 6 months. The mean AI was 31.4 (range: 29-35)°±2.1° in dysplastic hips. AI decreased to 26.5°±2.2°, 24.5°±2°, 21°±2.1° at sixth months, first and third years after treatment; respectively. The mean AI of non-dysplastic hips was 25.3°(range: 22-28)±2.1°; and decreased to 22.6°±2.4°, 21.1°±2°, 17.9°±1.8° at sixth months, first and third years follow-ups, respectively. At the end of the first six months, dysplastic hips had significantly better improvement in AI (4.9±2.1°) compared to non-dysplastic hips (2.7°±0.8°) (p<0.001). There was no significant difference in AI improvement after six months. Conclusion:Primary acetabular dysplasia should not be ignored despite normal previous physical and ultrasonographic examination. Abduction orthosis may be used in the treatment of children with primary AD older than six months.

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Section: Discussionmentioning

confidence: 85%

mentioning

confidence: 99%

Abduction Orthosis in Treatment of Primary Acetabular Dysplasia: Results of Three Years Follow-up

Yüksel¹,

Ünlü²,

Ersan³

et al. 2022

acmr

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“…There is extensive literature discussing the strengths of both US and plain films for the diagnosis of DDH, as well as the incidence of late-presenting dysplasia in various cohorts 11,12,19–21. Barrera et al22 discuss the various imaging techniques that are utilized over the course of treatment for DDH.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Late Dysplasia Based on Ultrasound and Plain X-Ray at 6 Months

Salton

Carry

Hadley-Miller

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Developmental dysplasia of the hip represents a spectrum of deformity. Residual dysplasia at 2 years of age is associated with an increased risk for osteoarthritis and functional limitations. We compared the prognostic value of 6-month imaging modalities and aimed to identify optimal diagnostic metrics for the prediction of residual dysplasia. Methods: After IRB approval, patients who underwent Pavlik treatment between 2009 and 2018 with 2-year follow-up were identified. Sonographs [ultrasound (US)] and radiographs (x-ray) were obtained at 6-month and 2-year-old visits. Dysplasia at 2 years was defined as an acetabular index (AI) > 24 degrees. Receiver operating characteristic curves were constructed to quantitatively compare the prognostic ability of US and x-raybased measures at 6 months. Youden's index [(YI) (values range from 0 (poor test) to 1 (perfect test)] was used to evaluate existing cutoffs at 6 months of age (normal measurements: alpha angle (AA) ≥ 60 degrees, femoral head coverage (FHC) ≥ 50%, and AI <30 degrees) relative to newly proposed limits. Results: Fifty-nine patients were included, of which 28.8% of patients (95% CI: 17.3 to 40.4%) had acetabular dysplasia at 2 years. After adjusting for sex, AA [Area under the Curve (AUC): 80] and AI (AUC: 79) at 6 months of age were better tests than FHC (AUC: 0.77). Current diagnostic cutoffs for AA (YI: 0.08), AI (YI: 0.0), and FHC (YI: 0.06) at 6 months had poor ability to predict dysplasia at 2 years. A composite test of all measures based on proposed cutoffs (AA ≥ 73 degrees, FHC > 62% and AI ≤ 24 degrees) was a better predictor of dysplasia at 2 years (Youden's index (YI): 0.63) than any single metric. Conclusions: The rate of residual dysplasia remains concerning. The 6-month x-ray and US both play a role in the ongoing management of the developmental dysplasia of the hip. The prediction of dysplasia is maximized when all metrics are considered collectively. Existing parameters were not accurate; We recommend the following cutoffs: AA ≥ 73 degrees, FHC > 62%, and AI ≤ 24 degrees. These cutoffs must be validated.

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“…Graf type IIc hips are marginally more difficult to treat than less severe diagnoses, understandably requiring longer treatment lengths and more aggressive interventions [18,19]. Better outcomes are often associated with a younger age at treatment initiation while the hip is still undeveloped [10,20,21]. Regardless of severity or Graf type, DDH does not have a treatment protocol that is universally agreed upon in the orthopedic community.…”

Section: Discussionmentioning

confidence: 99%

Twelve-week standard of care protocol longer than median time to normalization among IIc hips treated with Pavlik harness

Salton

Carry

Freeman

et al. 2022

Journal of Pediatric Orthopaedics B

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Best treatment protocols for infants with developmental dysplasia of the hip (DDH) are poorly defined. This study estimates the time to normalization among Graf IIc hips undergoing Pavlik harness treatment. Following institutional review board approval, patients referred for DDH evaluation at a pediatric institution between 2009 and 2018 (n = 1424 hips/712 patients) were identified. We isolated all Graf IIc hips that underwent Pavlik harness treatment (n = 132 hips/n = 106 patients). Demographic and outcome measures were collected. Normalization was defined as alpha angle greater than or equal to 60° and femoral head coverage greater than or equal to 50%. Kaplan–Meier and Cox proportional hazards regression analyses modeled time to normalization and identified factors associated with earlier normalization. Median time to normalization was 7.0 weeks. At 12 weeks standard treatment, 85.8% [95% confidence interval (CI): 80.2–91.9%] had normalized. Greater femoral head coverage [hazard ratio (HR) per 1% increase: 1.03; 95% CI: 1.01–1.05; P = 0.0068] and hip stability at treatment initiation (HR unstable vs. stable: 0.64; 95% CI: 0.44–0.93; P = 0.0192) were associated with longer time to normalization. Some patients may not need 12 weeks of Pavlik bracing, particularly those with stable presentation who normalize before week 12. Shorter treatment lengths offer benefit without sacrificing long-term outcomes. Findings reinforce growing evidence that femoral head coverage should be a more significant consideration during diagnosis and instability is a concerning finding on examination.

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

Cited by 20 publications

References 28 publications

Abduction Orthosis in Treatment of Primary Acetabular Dysplasia: Results of Three Years Follow-up

Abduction Orthosis in Treatment of Primary Acetabular Dysplasia: Results of Three Years Follow-up

Prediction of Late Dysplasia Based on Ultrasound and Plain X-Ray at 6 Months

Twelve-week standard of care protocol longer than median time to normalization among IIc hips treated with Pavlik harness

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