The natural history of abnormal ultrasound findings in hips of infants under six months of age

Sakkers, R. J. B.; Pollet, Virginie

doi:10.1302/1863-2548.12.180056

Cited by 29 publications

(37 citation statements)

References 42 publications

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“…In total, 10 out of 49 patients (20.4%) in the active surveillance group received treatment. This is in accordance to our recently published findings on the natural history of sonographic stable hips under six months of age where more than 80% will normalize without treatment 20 . This implies that even less patients will need treatment and the sonographic surveillance period can be extended until 6 months of age for Graf type IIb hips.…”

Section: Discussionsupporting

confidence: 93%

Abduction treatment in stable hip dysplasia does not alter the acetabular growth: results of a randomized clinical trial

Pollet

Castelein

Sande

et al. 2020

Sci Rep

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Background The effect of bracing over natural history of stable dysplastic hips is not well known. This multicenter randomized trial aimed at objectifying the effect of abduction treatment versus active surveillance in infants of 3 to 4 months of age. Methods Patients were randomized to either Pavlik harness or active surveillance group. Ultrasound was repeated at 6 and 12 weeks post randomization. the primary outcome was the degree of dysplasia using the Graf α-angle at 6 months of age. The measurement of the acetabular index (Ai) on plain pelvis X-rays was used to identify persistent dysplasia after 9 months and walking age (after 18 months). Findings The Pavlik harness group (n = 55) and active surveillance group (n = 49) were comparable for predictors of outcome. At 12 weeks follow-up the mean α-angle was 60.5° ± 3.8° in the Pavlik harness group and 60.0° ± 5.6° in the active surveillance group. (p = 0.30). Analysis of secondary outcomes (standard of care) showed no treatment differences for acetabular index at age 10 months (p = 0.82) and walking age (p = 0.35). Interpretation Pavlik harness treatment of stable but sonographic dysplastic hips has no effect on acetabular development. Eighty percent of the patients will have a normal development of the hip after twelve weeks. therefore, we recommend observation rather than treatment for stable dysplastic hips.

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Section: Discussionsupporting

confidence: 93%

Abduction treatment in stable hip dysplasia does not alter the acetabular growth: results of a randomized clinical trial

Pollet

Castelein

Sande

et al. 2020

Sci Rep

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“…Recent research by Pollet and colleagues indicates that Pavlik treatment is not of added value for well-centered dysplastic hips, as the vast majority of these hips tend to normalize during growth. 24 , 25 In contrast, 20% of the stable dysplastic hips in the study by Pollet and colleagues did eventually received treatment. Furthermore, a considerable proportion of patients with stable dysplastic hips do develop residual dysplasia.…”

Section: Discussionmentioning

confidence: 90%

Timing of Repeat Ultrasound Examination in Treatment of Stable Developmental Dysplasia of the Hip

Theunissen

Steen

Douveren

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Worldwide a wide variation exists in duration of Pavlik harness treatment for infants up to 6 months with stable developmental dysplasia of the hip (DDH). The purpose of this study was to evaluate whether shortening the time to first routine follow-up ultrasound after initiation of Pavlik harness treatment would reduce treatment duration and whether this influenced radiologic outcome at 1 year of age. Furthermore, predictors of higher acetabular index (AI) at 1 year of age were investigated. Methods: A retrospective study was conducted in infants with stable DDH (Graf IIb and IIc) diagnosed and treated between 2015 and 2017. Two groups were identified: first routine follow-up ultrasound at 12 weeks after Pavlik harness initiation (group I) and first routine follow-up ultrasound at 6 weeks after Pavlik harness initiation (group II). In both groups, treatment was continued until repeat ultrasound measurements (every 6 wk) showed a normalized hip. Radiologic outcome at 1 year of age was defined as residual dysplasia measured on an anteroposterior hip radiograph according to the Tönnis table. Results: A total of 222 infants were included. The median time of Pavlik harness treatment was 12 weeks (interquartile range, 11.9 to 12.3) in group I compared with 6.1 weeks (interquartile range, 6.0 to 7.5) in group II ( P <0.001). Residual dysplasia at 1 year of age was detected in 20 infants (16.8%) in group I compared with 11 infants (10.7%) in group II ( P =0.189). The multivariable prediction model showed that positive family history and lower baseline alpha angle correlate with a higher AI at 1 year of age. Conclusions: First routine follow-up ultrasound can be safely brought forward from 12 to 6 weeks after Pavlik harness initiation. Furthermore, infants with a positive family history for DDH and an initial low alpha angle are at higher risk to have a higher AI at 1 year of age. Level of Evidence: Level III—retrospective study.

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“…7 However, 5% of sonographically immature hips can deteriorate over time. 1313 So, it is better to include younger infants who are known to have bilateral mature hips at birth in the control group rather than to include the older infants who may initially have immature or even dysplastic hips, which then spontaneously resolve and become mature over time and are considered mature during ultrasound examination over three months of age.…”

Section: Discussionmentioning

confidence: 99%

Associations between risk factors and developmental dysplasia of the hip and ultrasonographic hip type: A retrospective case control study

Ömeroğlu

Akceylan

Köse

2019

Journal of Children's Orthopaedics

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Purpose We aimed to revisit the correlation between the previously defined risk factors and the occurrence of developmental dysplasia of the hip (DDH) and to assess the influence of these factors on the ultrasonographic type of hip dysplasia according to the Graf’s classification in patients with DDH. Methods Data of healthy infants (mean age 33 days) who had bilateral mature (normal) hips (Graf type I) were compared with the data of infants (mean age 105 days) who were treated by abduction brace due to unilateral or bilateral DDH (Graf type IIa- and worse hips). Results Infants with at least one risk factor had a significantly higher rate of DDH than those with no risk factors (p < 0.001). Likewise, infants with more than one risk factor had a significantly higher rate of DDH than those with only one risk factor (p = 0.008). Family history, breech presentation and swaddling were found to be the three significant risk factors related to the development of DDH. Family history, swaddling and oligohydramnios were found to be the three significant risk factors correlated with a higher rate of unstable/decentred hip(s) (Graf types D/III/IV) in patients with DDH. Conclusion The risk of DDH significantly increases in infants who have more than one risk factor for DDH. Positive family history and postnatal traditional swaddling are the two main factors both in the aetiology of DDH and in development of a more severe hip dysplasia in patients with DDH. Besides, breech presentation increases the risk of development of DDH and oligohydramnios leads to development of a more severe hip dysplasia in patients with DDH. By introducing these four variables as ‘absolute risk factors for DDH’ to the selective newborn hip screening programmes, the sensitivity and specificity of these programmes may be optimized and the risk of delayed diagnosis may be lessened. Level of Evidence Level III prognostic study

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The natural history of abnormal ultrasound findings in hips of infants under six months of age

Cited by 29 publications

References 42 publications

Abduction treatment in stable hip dysplasia does not alter the acetabular growth: results of a randomized clinical trial

Abduction treatment in stable hip dysplasia does not alter the acetabular growth: results of a randomized clinical trial

Timing of Repeat Ultrasound Examination in Treatment of Stable Developmental Dysplasia of the Hip

Associations between risk factors and developmental dysplasia of the hip and ultrasonographic hip type: A retrospective case control study

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