Álvarez SF, Castañeda LP

Language: Spanish
References: 23
Page: 29-34
PDF size: 172.50 Kb.

ABSTRACT

Purpose: To determine whether there are any early ultrasound findings that are associated with a late failure in the treatment of developmental dysplasia of the hip (DDH) with a Pavlik harness. Methods: A prospective study of patients with DDH treated with a Pavlik harness was undertaken. Ultrasound examination of the hips was performed initially and at two week intervals until treatment was completed. Hips were classified as either: dislocated and non-reducible, dislocated but reducible, unstable dysplasia and stable dysplasia. If the hip did not reduce at two-weeks we suspended the use of the harness. The α angle and distance from the femoral head to the acetabulum were considered as independent variables on the two-week examination. We began with 52 patients (70 hips) but excluded 12 patients (16 hips) who did not reduce at two-weeks; we included 40 patients with 54 hips. Results: Mean age at the start of treatment was 2.72 months (range 0.5 to 6 months). There were 23 left hips, 3 right hips and 14 patients with bilateral disease. Four hips were considered dislocated and non-reducible (on initial exam but reduced at two-weeks), 27 were dislocated and reducible, 15 with unstable dysplasia, and 8 with stable dysplasia. Mean time in the harness was 3.37 months. Mean follow-up was 2.4 years (range 2 to 3.4 years). We considered outcome to be good in 29 patients; there were 6 cases with residual dysplasia and 5 cases of redislocation. For the cases with residual dysplasia the mean α angle (at two-weeks in the harness) was 37.3° whereas for the group with a good result it was 45.3° (p = 0.03). The mean distance between the femoral head and the acetabulum (at two-weeks in the harness) for the cases which redislocated was 13.6 mm whereas for the group with a good result it was 6.2 mm (p = 0.04). Conclusion: We found a 28% rate of late failure and that an α angle of less than 40° and distance between the femoral head and the acetabulum greater tan 12 mm after two weeks in the Pavlik harness were predictive of late failure of the treatment. The threshold for suspending use of the Pavlik harness should be lowered when the early ultrasound findings are predictive of failure. Level of evidence: II prognostic study.

REFERENCES

1. Borges JLP, Kumar SJ, Guille JT. Congenital dislocation of the hip in boys. J Bone Joint Surg (Am) 1995; 77: 975-84.

2. Bradley J, Wetherill M, Benson MKD. Splintage for congenital dislocation of the hip: is it safe and reliable? J Bone Joint Surg (Br) 1987; 69: 257-63.

3. Fujioka F, Terayama K, Sugimoto N, Tanikawa H. Long-term results of congenital dislocation of the hip treated with the Pavlik harness. J Pediatr Orthop 1995; 15: 747-52.

4. Graf R. Guide to sonography of the infant hip. New York: Thieme Medical, 1987.

5. Grill F, Bensahel H, Canadell J et al. The Pavlik harness in the treatment of congenital dislocating hip: report on a multicenter study of the European Paediatric Orthopaedic Society. J Pediatr Orthop 1988; 8: 1-8.

6. Lerman J, Emans JB, Millis MB, Share J, Zurakowski D, Kasser JR. Early failure of Pavlik harness treatment for developmental hip dysplasia: Clinical and ultrasound predictors. J Pediatr Orthop 2001; 2: 348-353.

7. Hangen DH, Kasser JR, Emans JB et al. The Pavlik harness and developmental dysplasia of the hip: has ultrasound changed treatment patterns? J Pediatr Orthop 1995; 15: 729-35.

8. Harding MGB, Harcke HT, Bowen JR et al. Management of dislocated hips with Pavlik harness treatment and ultrasound monitoring. J Pediatr Orthop 1997; 17: 189-98.

9. Harris IE, Dickens R, Menelaus MB. Use of the Pavlik harness for hip displacements: when to abandon treatment. Clin Orthop 1992; 281: 29-33.

10. Johnson AH, Aadalen RJ, Eilers VE et al. Treatment of congenital hip dislocation and dysplasia with the Pavlik harness. Clin Orthop 1981; 155: 25-9.

11. Jones GT, Schoenecker PL, Dias LS. Developmental hip dysplasia potentiated by inappropriate use of the Pavlik harness. J Pediatr Orthop 1992; 12: 722-6.

12. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg (Am) 1980; 62: 876-88.

13. Kalamchi A, MacFarlane R. The Pavlik harness: results in patients over three months of age. J Pediatr Orthop 1982; 2: 3-8.

14. Malkawi H. Sonographic monitoring of the treatment of developmental disturbances of the hip by the Pavlik harness. J Pediatr Orthop 1998; 7: 144-9.

15. Taylor GR, Clarke NMP. Monitoring the treatment of developmental dysplasia of the hip with the Pavlik harness. J Bone Joint Surg (Br) 1997; 79: 719-23.

16. Suzuki S. Ultrasound and the Pavlik harness in CDH. J Bone Joint Surg (Br) 1993; 75: 483-7.

17. Morin C, Harcke HT, MacEwen GD. The infant hip: real-time US assessment of acetabular development. Radiology 1985; 157: 673-7.

18. Hoel PG. Introduction to mathematical statistics. New York: Wiley, 1984: 238-43.

19. Mubarak S, Garfin S, Vance R et al. Pitfalls in the use of the Pavlik harness for treatment of congenital dysplasia, subluxation, and dislocation of the hip. J Bone Joint Surg (Am) 1981; 63: 1239-48.

20. Ramsey PL, Lasser S, MacEwen GD. Congenital dislocation of the hip: use of the Pavlik harness in the child during the first six months of life. J Bone Joint Surg (Am) 1976; 58: 1000-4.

21. Share JC, Teele RL. Ultrasonography of the infant hip: a practical approach. Appl Radiol 1992; 21: 27-34.

22. Viere RG, Birch JG, Herring JA et al. Use of the Pavlik harness in congenital dislocation of the hip: an analysis of failures of treatment. J Bone Joint Surg (Am) 1990; 72: 238-44.

23. Mooney JF, Kasser JR. Brachial plexus palsy as a complication of Pavlik harness use. J Pediatr Orthop 1994; 14: 677-9.