scholarly journals Treatment of the Developmental Dysplasia of the Hip with an Abduction Brace in Children up to 6 Months Old

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Raphaël Wahlen ◽  
Pierre-Yves Zambelli
Keyword(s):  
Femoral Head ◽  
Retrospective Analysis ◽  
Reduction Rate ◽  
Developmental Dysplasia ◽  
Pavlik Harness ◽  
Treatment Procedure ◽  
Hip Reduction ◽  
One Year ◽  
Dysplasia Of The Hip

Introduction. Use of Pavlik harness for the treatment of DDH can be complicated for parents. Any misuse or failure in the adjustments may lead to significant complications. An abduction brace was introduced in our institution, as it was thought to be easier to use.Aim. We assess the results for the treatment of DDH using our abduction brace in children of 0–6 months old and compare these results with data on treatments using the Pavlik harness.Method. Retrospective analysis of patients with DDH from 0 to 6 months old at diagnosis, performed from 2004 to 2009. Outcomes were rates of reduction of the hip and avascular necrosis of the femoral head (AVN). Follow-up was at one year and up to 4 years old.Results. Hip reduction was successful in 28 of 33 patients (85%), with no AVN.Conclusion. Our results in terms of hip reduction rate and AVN rate are similar to those found in literature assessing Pavlik harness use, with a simpler and comfortable treatment procedure.

PAVLIK HARNESS IN THE TREATMENT OF DEVELOPMENTAL DYSPLASIA OF THE HIP — A CLINICAL AND ULTRASONOGRAPHIC STUDY

1999 ◽  
Vol 03 (01) ◽  
pp. 11-18
Author(s):  
J. C. Y. Cheng
Keyword(s):  
Success Rate ◽  
Reduction Rate ◽  
Developmental Dysplasia ◽  
Radiological Assessment ◽  
Pavlik Harness ◽  
Factors Affecting ◽  
Ultrasonographic Assessment ◽  
Dysplasia Of The Hip ◽  
Significant Factors

Eighty cases of early DDH treated with Pavlik harness over a 10-year period in one centre was followed up for a minimum of 2 years with a mean of 6.5 years. Sixty-five percent of the patients presented to the clinic before the age of 4 weeks, and 10% after 12 weeks. Sixty percent presented clinically as dislocated reducible hip, 25% as dislocated non-reducible hip, and 15% as dislocatable hip. Static and dynamic ultrasonographic grading revealed 65% as pathological hip and 35% as normal. Clinical and ultrasonographic assessment revealed that 2 weeks after commencement of the Pavlik Harness treatment, 78% of the hips were reduced and this increased after 4 weeks, to 91.2%. The most significant factors affecting the outcome were the age at the start of treatment and the clinical type of hip. A 95% success reduction rate was achieved for those treated before the age of 8 weeks and only 50% for those after this age. Ninety-five percent of the dislocated reducible hips and 100% of the dislocatable hips were successfully reduced. Of the initial dislocated irreducible hips, only 50% were successfully reduced. At the final follow-up, the clinical and radiological assessment showed an overall success rate of 84%. Avascular necrosis was only found in 1 case (1.25%).

Evolution of concentricity after closed reduction in developmental dysplasia of the hip

2020 ◽  
Vol 102-B (5) ◽  
pp. 618-626 ◽  
Author(s):  
Weizheng Zhou ◽  
Wudbhav N. Sankar ◽  
Fangfang Zhang ◽  
Lianyong Li ◽  
Lijun Zhang ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Joint Space ◽  
Developmental Dysplasia ◽  
Consecutive Series ◽  
The Mean ◽  
One Year ◽  
Safety And Stability ◽  
Dysplasia Of The Hip ◽  
Over Time

Aims The goal of closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) is to achieve and maintain concentricity of the femoral head in the acetabulum. However, concentric reduction is not immediately attainable in all hips and it remains controversial to what degree a non-concentric reduction is acceptable. This prospective study is aimed at investigating the dynamic evolution of the hip joint space after CR in DDH using MRI. Methods A consecutive series of patients with DDH who underwent CR since March 2014 were studied. Once the safety and stability were deemed adequate intraoperatively, reduction was accepted regardless of concentricity. Concentricity was defined when the superior joint space (SJS) and medial joint space (MJS) were both less than 2 mm, based on MRI. A total of 30 children, six boys and 24 girls, involving 35 hips, were recruited for the study. The mean age at CR was 13.7 months (3.5 to 27.6) and the mean follow-up was 49.5 months (approximately four years) (37 to 60). The joint space was evaluated along with the interval between the inverted and everted limbus. Results Only three hips (8.6%) were fully concentric immediately after CR. During follow-up, 24 hips (68.6%) and 27 hips (77.1%) became concentric at six months and one year, respectively. Immediate SJS after CR decreased from 3.51 mm to 0.79 mm at six months follow-up (p = 0.001). SJS in the inverted group decreased from 3.75 mm to 0.97 mm at six months follow-up. SJS or MJS in the everted group were less than those in the inverted group at each time of follow-up (p = 0.008, p = 0.002). Conclusion A stable, safe but non-concentric reduction achieved before the age of two years appears to improve over time with nearly 80% of hips becoming fully concentric by one year. Cite this article: Bone Joint J 2020;102-B(5):618–626.

Establishing reference values for the pubofemoral distance in normal infant medial hips by ultrasound

2020 ◽  
pp. 028418512093324
Author(s):  
Yongguang Ban ◽  
Qinhua Luan ◽  
Miao Shi ◽  
Bo Sun ◽  
Tianyou Li ◽  
...  
Keyword(s):  
Age Groups ◽  
Developmental Dysplasia ◽  
Pubic Bone ◽  
Normal Infant ◽  
Male And Female ◽  
Type Ia ◽  
Hip Reduction ◽  
And Gender ◽  
Dysplasia Of The Hip

Background Measuring the pubofemoral distance (PFD) is important for evaluating the effectiveness of hip reduction in the treatment of developmental dysplasia of the hip (DDH). However, reference PFD values have not been established in normal infants. Purpose To investigate variations in PFD values measured in normal infant medial hips stratified by age, laterality, and gender. Material and Methods A total of 240 infants diagnosed with Graf type Ia and/or Graf type Ib hips by ultrasonography were stratified into eight age groups: 0–1 month; 1–2 months; 2–3 months; 3–4 months; 4–5 months; 5–6 months; 6–7 months; and 7–12 months. The bilateral medial hips were scanned with transinguinal ultrasound. The PFD was defined as the distance between the lateral edge of the superior ramus of pubic bone and the medial edge of the femoral head. Inter-observer reproducibility was assessed. Results Among the 240 infants, there were 371 Graf type Ia hips and 109 Graf type Ib hips. Mean ± SD bilateral PFD values of eight groups were measured separately. There were no significant differences in mean PFD values for left or right hips (t = 0.946, P = 0.345) or mean bilateral PFD values in male and female infants (t = 1.445, P = 0.149). Mean PFD values increased linearly with age (left: r = 0.680, P < 0.0001; right: r = 0.682, P < 0.0001). Inter-observer reproducibility was excellent. Conclusion This study established reference PFD values from the medial hip in infants aged 0–12 months. PFD values increased with age, but were not significantly influenced by laterality or gender. These data provide detailed information that can support follow-up of infants treated for DDH.

scholarly journals Should closed reduction of the dislocated hip be attempted after failed Pavlik harness treatment in developmental dysplasia of the hip?

2021 ◽  
Vol 2 (8) ◽  
pp. 584-588
Author(s):  
Matthew Arneill ◽  
Aidan Cosgrove ◽  
Elaine Robinson
Keyword(s):  
Northern Ireland ◽  
Surgical Procedures ◽  
Closed Reduction ◽  
Developmental Dysplasia ◽  
General Anaesthetic ◽  
Pavlik Harness ◽  
Total Cohort ◽  
Clinically Significant ◽  
Dysplasia Of The Hip

Aims To determine the likelihood of achieving a successful closed reduction (CR) of a dislocated hip in developmental dysplasia of the hip (DDH) after failed Pavlik harness treatment We report the rate of avascular necrosis (AVN) and the need for further surgical procedures. Methods Data was obtained from the Northern Ireland DDH database. All children who underwent an attempted closed reduction between 2011 and 2016 were identified. Children with a dislocated hip that failed Pavlik harness treatment were included in the study. Successful closed reduction was defined as a hip that reduced in theatre and remained reduced. Most recent imaging was assessed for the presence of AVN using the Kalamchi and MacEwen classification. Results There were 644 dislocated hips in 543 patients initially treated in Pavlik harness. In all, 67 hips failed Pavlik harness treatment and proceeded to arthrogram (CR) under general anaesthetic at an average age of 180 days. The number of hips that were deemed reduced in theatre was 46 of the 67 (69%). A total of 11 hips re-dislocated and underwent open reduction, giving a true successful CR rate of 52%. For the total cohort of 67 hips that went to theatre for arthrogram and attempted CR, five (7%) developed clinically significant AVN at an average follow-up of four years and one month, while none of the 35 hips whose reduction was truly successful developed clinically significant AVN. Conclusion The likelihood of a successful closed reduction of a dislocated hip in the Northern Ireland population, which has failed Pavlik harness treatment, is 52% with a clinically significant AVN rate of 7%. As such, we continue to advocate closed reduction under general anaesthetic for the hip that has failed Pavlik harness. Cite this article: Bone Jt Open 2021;2(8):584–588.

scholarly journals Magnetic resonance imaging follow-up can screen for soft tissue changes and evaluate the short-term prognosis of patients with developmental dysplasia of the hip after closed reduction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xianghong Meng ◽  
Jianping Yang ◽  
Zhi Wang
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Femoral Head ◽  
Ligamentum Teres ◽  
Developmental Dysplasia ◽  
Resonance Imaging ◽  
Acetabular Head Index ◽  
Before And After ◽  
Dysplasia Of The Hip

Abstract Background Magnetic resonance imaging (MRI) can show the architecture of the hip joint clearly and has been increasingly used in developmental dysplasia of the hip (DDH) confirmation and follow-up. In this study, MRI was used to observe changes in the hip joints before and after closed reduction (CR) and to explore risk factors of residual acetabular dysplasia (RAD). Methods This is a prospective analysis of unilateral DDH patients with CR and spica cast in our hospital from October 2012 to July 2018. MRI and pelvic plain radiography were performed before and after CR. The labro-chondral complex (LCC) of the hip was divided into four types on MRI images. The variation in the thickening rate of the ligamentum teres, transverse ligaments, and pulvinar during MRI follow-up was analyzed, and the difference in cartilaginous acetabular head index was evaluated. The “complete relocation” rate of the femoral head was analyzed when the cast was changed for the last time, and the necrotic rate of the femoral head was evaluated after 18 months or more after CR. Lastly, the risk factors of RAD were analyzed. Results A total of 63 patients with DDH and CR were included. The LCC was everted before CR and inverted after CR, and the ligamentum teres, transverse ligaments, and pulvinar were hypertrophic before and after CR, and then gradually returned to normal shape. The cartilaginous acetabular head index gradually increased to normal values. Complete relocation was observed in 58.7% of femoral heads, while 8.6% had necrosis. The abnormalities in LCC was related to RAD (OR: 4.35, P = 0.03), and the rate of type 3 LCC in the RAD group was higher. However, the IHDI classification (P = 0.09); the “complete relocation” of femoral heads (P = 0.61); and hypertrophy of the ligamentum teres (P = 1.00), transverse ligaments (P = 1.00), and pulvinar (P = 1.00) were not related to RAD. Conclusions In this study, MRI can observe the variations of the abnormal soft tissue structures of the diseased hips after CR and spica casting, and can evaluate which hips will have RAD after CR. Therefore, we can utilize MRI in DDH patients appropriately.

Three-dimensional MRI analyses of prereduced femoral head sphericity in patients with developmental dysplasia of the hip after Pavlik harness failure

2018 ◽  
Vol 27 (5) ◽  
pp. 394-398
Author(s):  
Yuta Tsukagoshi ◽  
Hiroshi Kamada ◽  
Ryoko Takeuchi ◽  
Shogo Nakagawa ◽  
Yohei Tomaru ◽  
...  
Keyword(s):  
Femoral Head ◽  
Three Dimensional ◽  
Developmental Dysplasia ◽  
Pavlik Harness ◽  
Dysplasia Of The Hip

scholarly journals Aseptic necrosis of the femoral head in the course of haemophilia; a different clinical and radiological course compared to typical Legg-Calve-Perthes disease (twenty years of follow-up) – case report

2021 ◽  
Vol 86 (3) ◽  
pp. 93-95
Author(s):  
Grzegorz Kandzierski ◽  
◽  
Łukasz Matuszewski ◽  
Szymon Stec
Keyword(s):  
Femoral Head ◽  
Developmental Dysplasia ◽  
Perthes Disease ◽  
Haemophilia A ◽  
Factor Viii Level ◽  
Aseptic Necrosis ◽  
Haemophilic Arthropathy ◽  
Viii Level ◽  
Dysplasia Of The Hip

The authors analyse the course of aseptic necrosis of the femoral head in a 7-year-old boy with haemophilia A (factor VIII level - 0%) caused by massive haemarthrosis into the hip joint (joint tamponade). The patient’s clinical and radiological symptoms differed from those in classic LCP disease, and now, after 20 years, the consequences of necrosis do not confirm typical Perthes disease (LCP). Significant shortening (about 5 cm) of the limb and the X-ray image of the proximal end of the femur resemble the consequences of severe necrosis of the femoral head in the treatment of an infant with developmental dysplasia of the hip (DDH). The study presents necrosis of the femoral head in the course of haemophilia due to its extremely rare occurrence as opposed to haemophilic arthropathy typical for this disease. This description may also contribute to considerations on the etiopathology of LCP disease.

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