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

W.W.E.S. Theunissen*, M. van der Steen, F.Q.M.P. van Douveren, A.M.A. Witlox, J.J. Tolk

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Web of Science)

Abstract

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 Tonnis 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.
Original languageEnglish
Pages (from-to)203-208
Number of pages6
JournalJournal of Pediatric Orthopaedics
Volume41
Issue number4
DOIs
Publication statusPublished - 1 Apr 2021

Keywords

  • developmental dysplasia of the hip
  • hip dysplasia
  • DDH
  • Pavlik harness
  • residual dysplasia
  • PAVLIK HARNESS TREATMENT
  • NATURAL-HISTORY
  • ACETABULAR DYSPLASIA
  • CHILDREN
  • CLASSIFICATION
  • RELIABILITY
  • INFANTS
  • ANGLES
  • RISK

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