Successful Pavlik treatment in late-diagnosed developmental dysplasia of the hip

Abstract

PurposeThe objective of this study was to evaluate success and complication rates of the Pavlik harness in late-diagnosed hip dislocation (developmental dysplasia of the hip, DDH). We also set out to assess the additional value of an abduction brace for three to six months, when successful reduction using the Pavlik harness was achieved.MethodsWe included 31 patients (31 hips, 28 female, right/left = 4/27) with late-diagnosed hip dislocation treated with a Pavlik harness between 1995 and 2008. The average age at the start treatment was 27 weeks (21-57). None were lost to follow-up; the mean follow-up was 4.2 years (two-10). Of these patients, 61 % were classified as Tönnis type 2, 32 % as type 3 and 7 % as type 4.ResultsOf 31 hips, 20 (65 %) were successfully reduced after the use of the Pavlik harness. The average duration of Pavlik treatment was seven weeks (three-12). The mean time to stable reduction was six weeks (three-11), after which the patients were weaned off the Pavlik harness. The mean age at final treatment was 19 months (12-28). Five patients (15.0 %) developed radiological signs of osteonecrosis (Kalamchi and MacEwen classification; two group I, one group II and two group IV). When we compared the different Tönnis types a significant difference in successful reduction was found. Seventeen (81 %) of Tönnis type 2 dislocated hips were successfully reduced, while only two (25 %) of Tönnis type 3-4 hips were (odds ratio 25, p = 0.001). Clinical examination (e.g. limited abduction, positive Ortolani, Barlow or Galeazzi) at the time of diagnosis was not significantly related to the success rate of the Pavlik treatment. The mean acetabular index (AI) significantly improved from 36.5 to 30.5° after initial Pavlik treatment to 22.3° at final follow-up (4.1 years).ConclusionsProlonged use of the Pavlik harness in late-diagnosed hip dislocation (DDH) Tönnis type <3 is a safe and successful treatment option in the older infant. Although the AI was significantly reduced after the abduction brace, its additional use remains debatable, as no control group was evaluated.

Treatment of developmental dysplasia of the hip with the Pavlik harness in children under six months of age: Indications, results and failures

“…Increased lateral and superior displacement of the femoral head assessed by quantitative measurements, 29 , 30 complete dislocation of the femoral head (CSHD grade III and IV hips) 12 , 26 , 31 , 44 and an initial acetabular index of more than 36°29 were reported as the radiographic indicators for failure.…”

Closed reduction with or without adductor tenotomy for developmental dysplasia of the hip presenting at walking age

“… 17 Although most authors do not recommend the use of the Pavlik harness after 6 mo of age, 18 Pollet et al 19 treated late diagnosed infants between the ages of 6 and 24 mo with a harness claiming encouraging results in Graf type 3 hips but failure in Graf 4 hips. 19 Van de Sande et al 20 reported successful treatment with a Pavlik harness in children between the ages of 5 to 13 mo with better results being achieved in initially less severe dislocated dysplastic hips. 20 The modified Hoffmann-Daimler method used in late-presenting or neglected developmental dysplasia of the hip showed in a series involving 95 hips satisfactory radiographic results in 88 (93%) of the dislocated hips.…”

“… 19 Van de Sande et al 20 reported successful treatment with a Pavlik harness in children between the ages of 5 to 13 mo with better results being achieved in initially less severe dislocated dysplastic hips. 20 The modified Hoffmann-Daimler method used in late-presenting or neglected developmental dysplasia of the hip showed in a series involving 95 hips satisfactory radiographic results in 88 (93%) of the dislocated hips. 21 Zionts and MacEwen 22 reported the results in 51 congenitally dislocated hips in 42 children who were between 1 and 3 yr of age at the time of treatment.…”

Analyses of outcomes of one-stage operation for treatment of late-diagnosed developmental dislocation of the hip: 864 hips followed for 3.2 to 8.9 years

“…Although treatment of DDH is often successful in infants, it is still a challenge in late-diagnosed DDH [ 7 , 8 ]. Late diagnosis has to be avoided by ultrasound screening in technique described by Graf way [ 9 ]. Muscle contractures around the joint and soft tissue pathology hinder reduction and prevent normal development of the femoral head by inflicting pressure [ 4 ].…”