Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age

Dwan, Kerry; Kirkham, Jamie; Paton, R. W.; Morley, Emma; Newton, Ashley W.; Perry, Daniel

doi:10.1002/14651858.cd012717.pub2

Cited by 14 publications

(13 citation statements)

References 94 publications

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“…8 The use of orthoses, such as Pavlik harness, in early infancy for various reasons can potentially impact healthy musculoskeletal development. 6,[9][10][11][12] Our results indicate that non-operative treatment of DDH with the Pavlik harness did not significantly affect the infant's ability to sit unaided or walk independently. Although the Pavlik harness restricts hip adduction and extension, it does not affect lower extremity muscle activities as it allows for active hip movements, as demonstrated by Siddicky et al 10 Zgoda et al 13 evaluated the locomotor development of 100 DDH patients treated with the Koszla abduction brace.…”

Section: Discussionmentioning

confidence: 95%

Effect of the Pavlik harness used in the treatment of developmental dysplasia of the hip on unaided sitting and independent walking age

Ucpunar,

Sevencan,

Erbas

et al. 2023

Journal of Children's Orthopaedics

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Background: Pavlik harness is the most widely used orthosis in the treatment of developmental dysplasia of the hip. The aim of this study was to evaluate the effect of the Pavlik harness on the development of “unaided sitting” and “independent walking” in infants with developmental dysplasia of the hip. Methods: This prospective study, conducted from 2017 to 2020, included infants undergoing Pavlik harness therapy. Inclusion criteria comprised gestational age > 37 weeks, treatment initiation before 6 months of age, and no prior treatment for developmental dysplasia of the hip. We assessed treatment initiation age, treatment duration, and the age of achieving unaided sitting and independent walking. Results: In the patient group, unaided sitting commenced at a mean age of 6.8 ± 1.6 (range: 4–11) months, while independent walking began at a mean age of 12.7 ± 1.8 (range: 9–18) months. By 15 months, 92% of the patients achieved independent walking. In the control group, unaided sitting occurred at a mean age of 6.1 ± 1.1 (range: 4–8) months, and independent walking at 11.8 ± 1.6 (range: 9–18) months. A significant positive correlation was observed between the duration of Pavlik harness usage and the age of unaided sitting (p < 0.001) and independent walking (p < 0.001). Conclusion: Our study indicates that Pavlik harness treatment for developmental dysplasia of the hip is generally safe and does not lead to clinically significant delays in unaided sitting and independent walking. However, some minor delays may occur due to extended orthosis use. Level of evidence: level III—prospective cohort study.

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Section: Discussionmentioning

confidence: 95%

Effect of the Pavlik harness used in the treatment of developmental dysplasia of the hip on unaided sitting and independent walking age

Ucpunar,

Sevencan,

Erbas

et al. 2023

Journal of Children's Orthopaedics

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“…50 In fact, the AI is an essential objective measurement to evaluate hip dysplasia, namely in children from 4 months to 8 years old. 51 The optimal duration of PH treatment remains controversial; 47,52 the individualization of the treatment is recommended for each hip without strict time limits. 11 Multiple studies reported the mean duration of PH treatment to be between 8 and 11.7 weeks.…”

Section: Discussionmentioning

confidence: 99%

Acetabular index as an indicator of Pavlik harness success in grade I developmental dysplasia of the hip: A retrospective study

Yasin,

Al Karmi,

Suleiman

et al. 2023

Journal of Children's Orthopaedics

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Purpose: Some articles have focused on the effectiveness of the Pavlik harness treatment for unstable and dislocated hips, yet data on monitoring its effectiveness with the acetabular index remains elusive. Therefore, this study aimed to assess Pavlik harness effectiveness in infants ≤6 months diagnosed with grade I developmental dysplasia of the hip using acetabular index improvement and identify the possible predictors of successful Pavlik harness treatment. Methods: A retrospective review of infants with grade I acetabular dysplasia treated with a Pavlik harness and monitored with anteroposterior pelvis X-rays at presentation and follow-up. Successful treatment was defined as achieving an acetabular index <30°. Results: A total of 231 infants with acetabular dysplasia were treated with a Pavlik harness. A successful outcome was achieved in 135 infants (58.4%). Younger age, lower initial acetabular index, and patients with unilateral developmental dysplasia of the hip were significant predictors of a successful outcome. An age of 4.5 months or older was found to be the threshold for an unsuccessful result following Pavlik harness treatment, with a sensitivity of 65.2% and specificity of 57.3%. An initial acetabular index of 35.5° was found to be the threshold for an unsuccessful result, with a sensitivity of 83.7% and specificity of 61.5%. Conclusion: Pavlik Harness’s success in correcting the acetabular index in acetabular dysplasia patients was related to unilateral cases, a younger age at presentation, and a lower initial acetabular index. The thresholds for unsuccessful treatment were an age of 4.5 months or greater and an acetabular index of 35.5° or higher.

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“…Optimizing the nonoperative treatment strategy of infant DDH is important to improve outcomes, minimize complications, and reduce the need for surgical intervention. 2…”

Section: Introductionmentioning

confidence: 99%

“…3,4 As a result, published principles of DDH treatment are broadly permissive, which perpetuates wide practice variation and limits the ability to rigorously compare treatments and improve pathways. 2,5-7…”

Section: Introductionmentioning

confidence: 99%

“…Several international orthopaedic societies and a recent Cochrane Review have urgently called for the development of reproducible evidence-based pathways for nonoperative management of DDH in infants aged under six months. 2,5,6 Development of these protocols will reliably guide and predict the success of brace treatment, detail the risk of late radiological dysplasia, and characterize those hips which need closer follow-up. Evidence-based pathways will also form a baseline for comparative studies and generate questions for randomized controlled trials to further refine management and improve outcomes.…”

Section: Introductionmentioning

confidence: 99%

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A comprehensive nonoperative treatment protocol for developmental dysplasia of the hip in infants

Bradley,

Verma,

Maddock

et al. 2023

Bone Joint J

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AimsBrace treatment is the cornerstone of managing developmental dysplasia of the hip (DDH), yet there is a lack of evidence-based treatment protocols, which results in wide variations in practice. To resolve this, we have developed a comprehensive nonoperative treatment protocol conforming to published consensus principles, with well-defined a priori criteria for inclusion and successful treatment.MethodsThis was a single-centre, prospective, longitudinal cohort study of a consecutive series of infants with ultrasound-confirmed DDH who underwent a comprehensive nonoperative brace management protocol in a unified multidisciplinary clinic between January 2012 and December 2016 with five-year follow-up radiographs. The radiological outcomes were acetabular index-lateral edge (AI-L), acetabular index-sourcil (AI-S), centre-edge angle (CEA), acetabular depth ratio (ADR), International Hip Dysplasia Institute (IHDI) grade, and evidence of avascular necrosis (AVN). At five years, each hip was classified as normal (< 1 SD), borderline dysplastic (1 to 2 SDs), or dysplastic (> 2 SDs) based on validated radiological norm-referenced values.ResultsOf 993 infants assessed clinically and sonographically, 21% (212 infants, 354 abnormal hips) had DDH and were included. Of these, 95% (202 infants, 335 hips) successfully completed bracing, and 5% (ten infants, 19 hips) failed bracing due to irreducible hip(s). The success rate of bracing for unilateral dislocations was 88% (45/51 infants) and for bilateral dislocations 83% (20/24 infants). The femoral nerve palsy rate was 1% (2/212 infants). At five-year follow-up (mean 63 months (SD 5.9; 49 to 83)) the prevalence of residual dysplasia after successful brace treatment was 1.6% (5/312 hips). All hips were IHDI grade I and none had AVN. Four children (4/186; 2%) subsequently underwent surgery for residual dysplasia.ConclusionOur comprehensive protocol for nonoperative treatment of infant DDH has shown high rates of success and extremely low rates of residual dysplasia at a mean age of five years.Cite this article: Bone Joint J 2023;105-B(8):935–942.

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Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age

Abstract: Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age.

Cited by 14 publications

References 94 publications

Effect of the Pavlik harness used in the treatment of developmental dysplasia of the hip on unaided sitting and independent walking age

Effect of the Pavlik harness used in the treatment of developmental dysplasia of the hip on unaided sitting and independent walking age

Acetabular index as an indicator of Pavlik harness success in grade I developmental dysplasia of the hip: A retrospective study

A comprehensive nonoperative treatment protocol for developmental dysplasia of the hip in infants

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