Does a Graf Type-I Hip Justify the Discontinuation of Pavlik Harness Treatment in Patients with Developmental Dislocation of the Hip?
Background: To analyze the clinical data of patients aged < 6 months with developmental dislocation of the hip (DDH) treated with Pavlik Harness (PH) in order to identify the best time to terminate PH treatment. Method: Fifty-four patients (47 females, 7 males; 63 hips) met the inclusion criteria...
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| Format: | Article |
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MDPI AG
2022-05-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/9/5/752 |
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| author | Yiqiang Li Federico Canavese Yanhan Liu Jianping Wu Jingchun Li Zhe Yuan Qinghe Zhou Yuanzhong Liu Weidong Chen Hongwen Xu |
| author_facet | Yiqiang Li Federico Canavese Yanhan Liu Jianping Wu Jingchun Li Zhe Yuan Qinghe Zhou Yuanzhong Liu Weidong Chen Hongwen Xu |
| author_sort | Yiqiang Li |
| collection | DOAJ |
| description | Background: To analyze the clinical data of patients aged < 6 months with developmental dislocation of the hip (DDH) treated with Pavlik Harness (PH) in order to identify the best time to terminate PH treatment. Method: Fifty-four patients (47 females, 7 males; 63 hips) met the inclusion criteria and were included in the study; there were 33 (61.1%) left, 12 (22.2%) right and 9 (16.7%) bilateral DDH. The mean age at diagnosis was 11.8 ± 5.9 weeks (range, 1.4–25.5). All patients underwent fulltime PH treatment for about three months. At completion of PH treatment, patients were then divided into <i>Group A</i>, including patients with clinically stable hip joint and Graf type-I hip on ultrasound (US), and <i>Group B</i>, including patients with clinically stable hip joint and well-reduced hip on anterior-posterior (AP) radiographs without acetabular dysplasia. Six months after completion of PH treatment, the presence/absence of residual acetabular dysplasia (RAD) was evaluated on AP pelvis radiographs. The <i>t</i>-test and chi-square test were used to compare the differences in age, gender, side, Graf classification and RAD rate between the two groups of patients. Results: At completion of PH treatment, 45 hips were in <i>Group A</i> and 18 in <i>Group B</i>. There were no significant differences in age, gender, side, preoperative alpha angle and Graf classification between the two groups. Six months after discontinuation of PH, the AI in <i>Group A</i> (27.1° ± 6.8°) was significantly higher than that in <i>Group B</i> (21.9° ± 3.5°; <i>p</i> = 0.001); moreover 23 hips (51.1%) in <i>Group A</i> developed RAD compared to one hip in <i>Group B</i> (5.6%; <i>p</i> = 0.001). Among <i>Group A</i> patients, those with RAD were significantly older (13.7 ± 4.9 weeks) than those with normal hips (7.6 ± 3.8 weeks; <i>p</i> < 0.001); the incidence of RAD was significantly lower in patients with Graf type-II D hips (22.2%) than in patients with Graf type-III (70%) and type-IV hips (71.4%; <i>p</i> = 0.006). However, logistic regression analysis identified age as the only risk factor for RAD. All 24 hips with RAD (24/63, 38.1%) were treated with abduction braces. At final follow-up, AI in <i>Group A</i> (20.5° ± 3.3°) was not significantly different from that in <i>Group B</i> (21.9° ± 3.3°; <i>p</i> = 0.132). At the last follow-up visit, five hips (11.1%) in <i>Group A</i> still had RAD, compared to none in <i>Group B</i> (<i>p</i> = 0.31). Conclusions: In patients with DDH treated by PH, Graf type-I on US is not an absolute timing to terminate PH treatment. In addition, patients ≥ 13 weeks had a high risk of RAD despite PH treatment as 51.1% of infants developed RAD during follow up. Follow-up radiographs should be requested in all patients achieving Graf type-I hips at completion of PH treatment. |
| first_indexed | 2024-03-10T03:08:48Z |
| format | Article |
| id | doaj.art-851299f5139140869fc4798bbbdf292d |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-10T03:08:48Z |
| publishDate | 2022-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj.art-851299f5139140869fc4798bbbdf292d2023-11-23T10:31:51ZengMDPI AGChildren2227-90672022-05-019575210.3390/children9050752Does a Graf Type-I Hip Justify the Discontinuation of Pavlik Harness Treatment in Patients with Developmental Dislocation of the Hip?Yiqiang Li0Federico Canavese1Yanhan Liu2Jianping Wu3Jingchun Li4Zhe Yuan5Qinghe Zhou6Yuanzhong Liu7Weidong Chen8Hongwen Xu9Department of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, ChinaDepartment of Pediatric Surgery and Orthopedics, Jeanne de Flandre Hospital, Lille University Center, 59800 Lille, FranceDepartment of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, ChinaDepartment of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, ChinaDepartment of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, ChinaDepartment of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, ChinaDepartment of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, ChinaDepartment of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, ChinaDepartment of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, ChinaDepartment of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, ChinaBackground: To analyze the clinical data of patients aged < 6 months with developmental dislocation of the hip (DDH) treated with Pavlik Harness (PH) in order to identify the best time to terminate PH treatment. Method: Fifty-four patients (47 females, 7 males; 63 hips) met the inclusion criteria and were included in the study; there were 33 (61.1%) left, 12 (22.2%) right and 9 (16.7%) bilateral DDH. The mean age at diagnosis was 11.8 ± 5.9 weeks (range, 1.4–25.5). All patients underwent fulltime PH treatment for about three months. At completion of PH treatment, patients were then divided into <i>Group A</i>, including patients with clinically stable hip joint and Graf type-I hip on ultrasound (US), and <i>Group B</i>, including patients with clinically stable hip joint and well-reduced hip on anterior-posterior (AP) radiographs without acetabular dysplasia. Six months after completion of PH treatment, the presence/absence of residual acetabular dysplasia (RAD) was evaluated on AP pelvis radiographs. The <i>t</i>-test and chi-square test were used to compare the differences in age, gender, side, Graf classification and RAD rate between the two groups of patients. Results: At completion of PH treatment, 45 hips were in <i>Group A</i> and 18 in <i>Group B</i>. There were no significant differences in age, gender, side, preoperative alpha angle and Graf classification between the two groups. Six months after discontinuation of PH, the AI in <i>Group A</i> (27.1° ± 6.8°) was significantly higher than that in <i>Group B</i> (21.9° ± 3.5°; <i>p</i> = 0.001); moreover 23 hips (51.1%) in <i>Group A</i> developed RAD compared to one hip in <i>Group B</i> (5.6%; <i>p</i> = 0.001). Among <i>Group A</i> patients, those with RAD were significantly older (13.7 ± 4.9 weeks) than those with normal hips (7.6 ± 3.8 weeks; <i>p</i> < 0.001); the incidence of RAD was significantly lower in patients with Graf type-II D hips (22.2%) than in patients with Graf type-III (70%) and type-IV hips (71.4%; <i>p</i> = 0.006). However, logistic regression analysis identified age as the only risk factor for RAD. All 24 hips with RAD (24/63, 38.1%) were treated with abduction braces. At final follow-up, AI in <i>Group A</i> (20.5° ± 3.3°) was not significantly different from that in <i>Group B</i> (21.9° ± 3.3°; <i>p</i> = 0.132). At the last follow-up visit, five hips (11.1%) in <i>Group A</i> still had RAD, compared to none in <i>Group B</i> (<i>p</i> = 0.31). Conclusions: In patients with DDH treated by PH, Graf type-I on US is not an absolute timing to terminate PH treatment. In addition, patients ≥ 13 weeks had a high risk of RAD despite PH treatment as 51.1% of infants developed RAD during follow up. Follow-up radiographs should be requested in all patients achieving Graf type-I hips at completion of PH treatment.https://www.mdpi.com/2227-9067/9/5/752developmental dysplasia of the hipPavlik harnesship ultrasoundacetabular indexresidual acetabular dysplasia |
| spellingShingle | Yiqiang Li Federico Canavese Yanhan Liu Jianping Wu Jingchun Li Zhe Yuan Qinghe Zhou Yuanzhong Liu Weidong Chen Hongwen Xu Does a Graf Type-I Hip Justify the Discontinuation of Pavlik Harness Treatment in Patients with Developmental Dislocation of the Hip? Children developmental dysplasia of the hip Pavlik harness hip ultrasound acetabular index residual acetabular dysplasia |
| title | Does a Graf Type-I Hip Justify the Discontinuation of Pavlik Harness Treatment in Patients with Developmental Dislocation of the Hip? |
| title_full | Does a Graf Type-I Hip Justify the Discontinuation of Pavlik Harness Treatment in Patients with Developmental Dislocation of the Hip? |
| title_fullStr | Does a Graf Type-I Hip Justify the Discontinuation of Pavlik Harness Treatment in Patients with Developmental Dislocation of the Hip? |
| title_full_unstemmed | Does a Graf Type-I Hip Justify the Discontinuation of Pavlik Harness Treatment in Patients with Developmental Dislocation of the Hip? |
| title_short | Does a Graf Type-I Hip Justify the Discontinuation of Pavlik Harness Treatment in Patients with Developmental Dislocation of the Hip? |
| title_sort | does a graf type i hip justify the discontinuation of pavlik harness treatment in patients with developmental dislocation of the hip |
| topic | developmental dysplasia of the hip Pavlik harness hip ultrasound acetabular index residual acetabular dysplasia |
| url | https://www.mdpi.com/2227-9067/9/5/752 |
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