Treatment Patterns and Outcomes of Stable Hips in Infants With Ultrasonic Dysplasia

Kim, Harry K.W.; Beckwith, Terri; Rocha, Adriana De La; Zepeda, Erica; Jo, Chan Hee; Sucato, Daniel J.

doi:10.5435/jaaos-d-17-00233

Cited by 13 publications

(18 citation statements)

References 15 publications

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“…Kim et al . ( 12 ) performed a prospective cohort study in infants diagnosed with stable dysplasia. Treatment with a Pavlik harness resulted in a mean AI of 20.9° ( s.d.…”

Section: Resultsmentioning

confidence: 99%

Treatment of centered developmental dysplasia of the hip under the age of 1 year: an evidence-based clinical practice guideline - Part 1

Bergen

Witte²,

Willeboordse³

et al. 2022

EFORT Open Reviews

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Despite the high incidence of developmental dysplasia of the hip (DDH), treatment is very diverse. Therefore, the Dutch Orthopedic Society developed a clinical practice guideline with recommendations for optimal and uniform treatment of DDH. This article summarizes the guideline on centered DDH (i.e. Graf types 2A–C). The guideline development followed the criteria of Appraisal of Guidelines for Research and Evaluation II. A systematic literature review was performed to identify randomized controlled trials and comparative cohort studies including children <1 year with centered DDH. Articles were included that compared (1) treatment with observation, (2) different abduction devices, (3) follow-up frequencies, and (4) discontinuation methods. Recommendations were based on Grading Recommendations Assessment, Development, and Evaluation, which included the literature, clinical experience and consensus, patient and parent comfort, and costs. Out of 430 potentially relevant articles, 5 comparative studies were included. Final guideline recommendations were (1) initially observe 3-month-old patients with centered DDH, start abduction treatment if the hip does not normalize after 6–12 weeks; (2) prescribe a Pavlik harness to children <6 months with persisting DDH on repeated ultrasonography, consider alternative abduction devices for children >6 months; (3) assess patients every 6 weeks; and (4) discontinue the abduction device when the hip has normalized or when the child is 12 months. This paper presents a summary of part 1 of the first evidence-based guideline for treatment of centered DDH in children <1 year. Part 2 presents the guideline on decentered DDH in a separate article.

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“…Kim et al . ( 12 ) performed a prospective cohort study in infants diagnosed with stable dysplasia. Treatment with a Pavlik harness resulted in a mean AI of 20.9° ( s.d.…”

Section: Resultsmentioning

confidence: 99%

Treatment of centered developmental dysplasia of the hip under the age of 1 year: an evidence-based clinical practice guideline - Part 1

Bergen

Witte²,

Willeboordse³

et al. 2022

EFORT Open Reviews

View full text Add to dashboard Cite

show abstract

“…2 standard deviations) around 1 year of age (mode 2: OR = 0.09; 95% CI: 0.02, 0.43; P = .002). In the second analysis, the interaction term between mode 2 and treatment (Pavlik harness Current diagnostic parameters for stable DDH only poorly correlate with outcome and cannot be used to identify hips that will have persistent or residual hip dysplasia with or without treatment (6)(7)(8)(9)(10)(11). In the context that around 80% of Graf II hips will develop to normal without treatment, there is a need to extract more data from US images to identify hips that are at risk for persistent or residual hip dysplasia at follow-up (8).…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, many well-centered stable hips are currently treated with an abduction device. Therefore, it can be concluded that a large percentage of these hips might be overtreated because more than 80% would have developed to normal without treatment (6)(7)(8)(9)(10)(11).…”

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confidence: 99%

Statistical Shape Modeling of US Images to Predict Hip Dysplasia Development in Infants

et al. 2022

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Background:The current widely applied Graf classification used on US images for developmental dysplasia of the hip in infants does not enable prediction of the development and outcome of well-centered stable dysplastic hips (Graf type II).Purpose: To use statistical shape modeling on US images to identify acetabular shape characteristics of Graf type II hips, which enable prediction of the development of Graf type II hips, and to identify which hips benefit from Pavlik harness treatment. Materials and Methods:In this secondary analysis of a prospective multicenter randomized trial on treatment of 104 infants aged 3-4 months with Graf type IIb or IIc hip dysplasia conducted between 2009 and 2015, a statistical shape model was developed on baseline US images. With multivariable logistic regression adjusted for infant sex and treatment (Pavlik harness treatment vs active observation), shape modes were correlated with the outcomes of persistent hip dysplasia on US images (a angle ,60°) after 12-week follow-up and residual hip dysplasia on pelvic radiographs (Tönnis classification: acetabular index greater than 2 standard deviations) around 1 year of age. An interaction term (treatment with mode) was used to investigate if this result depended on treatment.Results: Baseline US images were available in 97 infants (mean age, 3.37 years 6 0.43 [standard deviation]; 89 [92%] girls; 90 cases of Graf type IIb hip dysplasia; 52 cases treated with Pavlik harness). Shape modes 2 and 3 of the statistical shape modeling were associated with persistent hip dysplasia on US images (odds ratio [OR] = 0.43; P = .007 and OR = 2.39; P = .02, respectively). Mode 2 was also associated with residual hip dysplasia on pelvic radiographs (OR = 0.09; P = .002). The interaction term remained significant after multivariable analysis, indicating that Pavlik harness treatment was beneficial in patients with negative mode 2 values (OR = 12.46; P = .01). Conclusion:Statistical shape modeling of US images of infants with Graf type II dysplastic hips predicted which hips developed to normal or remained dysplastic and identified hips that benefited from Pavlik harness treatment.

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“…7 For stable hips with ultrasonic dysplasia in which the alpha angle is <55 , treatments could be observation or harness depending on physicians' decisions. 10 For Graf type IIa hip without clinical instability, the so-called 'physiological…”

Section: Discussionmentioning

confidence: 99%

Double diapering facilitates hip maturation in newborns

Lee

Kao

Chen

et al. 2022

Pediatrics & Neonatology

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double diaper; graf IIa immature hip; ultrasound Background: Double diapering may help to maintain a baby's hips in flexion and abduction posture, but the efficacy in facilitating hip maturation has never been verified. We investigated whether double diapering results in greater improvement of the alpha angle in newborn babies. Methods: This prospective study enrolled newborns with Graf type IIa immature hips and assigned them to the double-diaper or single-diaper group by the day of birth in a week. Parents were instructed on proper hip positioning, except for diapering. Change in the alpha angle from newborn to 1 month after birth, rate of improvement to bilateral Graf type I hips in 1 month, and number of ultrasound examinations and orthopaedic clinic visits in the first year were compared between the two groups. Results: Seventy newborns with 102 type IIa hips were included from January to December 2017. They were allocated to the double-diaper group (n Z 33) and single-diaper group (n Z 37). With a comparable sex ratio, gestational age, and newborn alpha angle, the double-diaper group had a greater increase of alpha angles in 1 month than the singlediaper group (þ7.9 vs. þ5.2 , t-test, p Z 0.011). Twenty-eight babies in the double-diaper group (84.8%) and 20 babies in the single-diaper group (54.1%) improved to having bilateral Graf type I hips (chi-square test, p Z 0.006). Under the same clinical management pathway, subsequent clinical visits and hip ultrasounds before 1 year were significantly reduced in the double-diaper group.

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Treatment Patterns and Outcomes of Stable Hips in Infants With Ultrasonic Dysplasia

Abstract: Level II: prospective cohort study.

Cited by 13 publications

References 15 publications

Treatment of centered developmental dysplasia of the hip under the age of 1 year: an evidence-based clinical practice guideline - Part 1

Treatment of centered developmental dysplasia of the hip under the age of 1 year: an evidence-based clinical practice guideline - Part 1

Statistical Shape Modeling of US Images to Predict Hip Dysplasia Development in Infants

Double diapering facilitates hip maturation in newborns

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