medigraphic.com
ISSN 2007-087X (Print)
Órgano Oficial de la Sociedad Mexicana de Ortopedia Pediátrica

2010, Number 1

<< Back Next >>

Rev Mex Ortop Ped 2010; 12 (1)

Tratamiento de la displasia del desarrollo de la cadera tipo Graf III y IV con el arnés de Pavlik

Flores A, Castañeda LP

Language: Spanish
References: 22
Page: 19-23
PDF size: 176.43 Kb.


ABSTRACT

Objective: To determine the rate of success in the treatment of developmental dysplasia of the hip with the Pavlik harness in patients classified by ultrasonography as being either Graf III or IV. Method: 28 patients (36 hips) were reviewed, 5 were right, 15 left and 8 bilateral; all were treated initially with the Pavlik harness. Minimum follow-up was 2 years (mean = 2.4 years). Average age at the start of treatment was 2.52 months. Twenty eight hips were classified as Graf III and 8 as Graf IV. Outcome was considered a success if a stable and concentric reduction was obtained and the acetabular index at final follow-up was less than 25°. The Fisher exact and Mann-Whitney U tests were applied for statistical analysis considering a p value less than 0.05 to be statistically significant. Results: 24 hips (66%) were considered a good result, 12 hips underwent subsequent procedures (7 closed reductions, 3 open reductions and 2 innominate osteotomies) and thus were considered failures of treatment. We found that out of the 20 patients with unilateral disease 16 (80%) had a good result; of the 8 patients with bilateral disease only 8 hips (50%) had a good result. According to the Graf classification for the 28 hips considered a type III, 22 (78%) had a good result; for the 8 patients considered Graf IV only 3 (37%) had a good result. The mean age at the start of treatment for the patients who ended with a good result was 1.8 months whereas for the group considered a failure it was 4.03 months (p = 0.02). No cases of avascular necrosis were found. Conclusion: the Pavlik harness is a safe and effective means of treating developmental dysplasia of the hip with a high rate of success. The success rate decreases significantly with increasing age, with the presence of bilateral disease and with increasing severity of the dysplasia as demonstrated by the Graf classification. Significance: Although the Pavlik harness should be considered the first line of treatment for infants with hip dysplasia, it should be noted that the success rate is lower in the presence of certain factors and another form of treatment should be considered when thesefactors are present. Level of evidence: IV, therapeutic.


REFERENCES

  1. 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.

  2. 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.

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

  4. 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.

  5. 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.

  6. 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.

  7. 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.

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

  9. 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.

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

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

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

  13. Castañeda P. Pediatric hip dysplasia and evaluation with ultrasound. Pediatric Health (2009): 3(5): 465-472.

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

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

  16. 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.

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

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

  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.




2020     |     www.medigraphic.com