scholarly journals Pavlik Harness in Treatment of Developmental Dysplasia of the Hip Joint a Prospective Short Term Follow up Clinical Study

2018 ◽  
Vol 6 (6) ◽  
pp. 88-92
Author(s):  
Hadi Kareem Hadi ◽  
Dhafer Fouad ◽  
Zaid Ali Jasim Shaban
Keyword(s):  
Clinical Study ◽  
Hip Joint ◽  
Developmental Dysplasia ◽  
Pavlik Harness ◽  
Short Term ◽  
Dysplasia Of The Hip

scholarly journals Acetabular reaming and sartorius muscle pedicle iliac bone grafting in the treatment of developmental dysplasia of the hip in older children: a retrospective study of 15 patients with more than two years follow-up

2020 ◽  
Vol 14 (3) ◽  
pp. 201-207
Author(s):  
Zhang Fan ◽  
Luo Cong ◽  
Liu Hang ◽  
Li Ming ◽  
Wu Jun ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Bone Grafting ◽  
Developmental Dysplasia ◽  
Iliac Bone ◽  
Sartorius Muscle ◽  
Acetabular Defect ◽  
Older Children ◽  
Short Term ◽  
Dysplasia Of The Hip

Purpose Despite the early diagnosis and treatment of developmental dysplasia of the hip (DDH), some older children still need open reduction. It is usually difficult to get a satisfactory reduction particularly in patients with acetabular defect. The purpose of this study was to evaluate the short-term outcomes of acetabulum reaming and sartorius muscle pedicle iliac bone grafting in the treatment of older children with DDH and acetabular defect. Methods The records of 15 patients with DDH (mean age 113.9 months (sd 29); 17 hips) who were treated with the reported technique between February 2015 and January 2017 were retrospectively reviewed. All patients acquired regular clinical and radiographic follow-ups, and alterations in the acetabular index, centre-edge angle and acetabular head index were measured. Joint function and radiographic results were evaluated with McKay and Severin modified criteria, respectively. Results A total of 15 patients were followed up for mean 32.4 months (sd 6.9). The percentages of excellent and good conditions were 94.1% (16/17) according to the Severin modified criteria and 88.2% (15/17) according to the McKay modified criteria. Avascular necrosis of the femoral head and redislocation only occurred in one hip. No cases of ankylosis or bone graft absorption occurred during the follow-up. Conclusion Reaming the acetabulum and sartorius muscle pedicle iliac bone grafting for repairing the acetabular defect can recover the arcuate structure by increasing the volume of the acetabulum, which is beneficial for achieving a concentric reduction. The short-term outcome was satisfactory, while the long-term results need to be further observed. Level of Evidence IV – retrospective study

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%).

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 Effect of abduction on avascular necrosis of the femoral epiphysis in patients with late-detected developmental dysplasia of the hip treated by closed reduction: a MRI study of 59 hips

2019 ◽  
Vol 13 (5) ◽  
pp. 438-444 ◽  
Author(s):  
Y. H. Liu ◽  
H. W. Xu ◽  
Y. Q. Li ◽  
K. Hong ◽  
J. C. Li ◽  
...  
Keyword(s):  
Avascular Necrosis ◽  
Hip Joint ◽  
Closed Reduction ◽  
Developmental Dysplasia ◽  
Abduction Angle ◽  
Normal Side ◽  
Hip Abduction ◽  
The Mean ◽  
Dysplasia Of The Hip

Purpose The purpose of this study was to explore whether increasing the hip abduction angle would increase the incidence of avascular necrosis (AVN) in patients with late- detected developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization. Methods A total of 55 patients (59 hips) with late-detected DDH underwent MRI after CR. Hip abduction angle and hip joint distance were measured on postoperative MRI transverse sections. The acetabular index and centre-edge angle were measured on plain radiographs at the last follow-up. The presence of AVN according to Kalamchi and McEwen’s classification was assessed. We retrospectively analyzed the associations among abduction angles, hip joint distances, radiographic parameters, AVN and final outcomes, exploring the relationship between hip joint abduction angle and AVN rate. Results The mean age at the time of CR was 14.4 months SD 5.5 (6 to 28), and the mean follow-up was 26.2 months SD 8.1 (12.4 to 41.7). The mean hip abduction angle was 70.2° SD 7.2° (53° to 85°) on the dislocated side and 63.7° SD 8.8° (40° to 82°) on the normal side; the mean hip joint distance was 5.1 mm SD 1.9 (1.3 to 9.1) on the dislocated side and 2.2 mm SD 0.6 on the normal side (1.3 to 3.3). Eight of 59 hips (13.6%) developed AVN. Neither the amount of abduction nor hip joint distance increased the AVN rate (p = 0.97 and p = 0.65, respectively) or the dislocation rate (p = 0.38 and p = 0.14, respectively). Conclusion Abduction angle up to 70.2° following CR did not increase the AVN rate in children aged six to 28 months with late-detected DDH treated by CR. Level of evidence III.

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.

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