Failed Pavlik harness treatment for DDH as a risk factor for avascular necrosis
Failed Pavlik harness treatment for DDH as a risk factor for avascular necrosis
BACKGROUND: Avascular necrosis (AVN) of the femoral head is an irreversible complication seen in the treatment of developmental dysplasia of hip (DDH) with the Pavlik harness. Its incidence is reported to be low after successful reduction of the hip but high if the hip is not concentrically relocated. We aim to investigate its incidence after failed Pavlik harness treatment.
METHODS: We prospectively followed up a group of children who failed Pavlik harness treatment for DDH treated at our institution by the senior author between 1988 and 2001 and compared their rates of AVN with a group of children who presented late and hence were treated surgically. AVN was graded as described by Kalamchi and MacEwen and only grade 2 to 4 AVN was considered significant and included in the analysis.
RESULTS: Thirty-seven hips were included in the failed Pavlik group (group 1) and 86 hips in the no Pavlik group (group 2). Ten hips in group 1 developed AVN (27%), whereas only 7 hips in group 2 (8%) developed AVN; the odds of developing AVN after failed Pavlik treatment was 4.7 (95% confidence interval, 1.3-14.1) (P=0.009) with a relative risk of 3.32 (range, 1.37 to 8.05).
CONCLUSIONS: There was no statistically significant association observed with duration of splintage and severity of AVN (Spearman's correlation, -0.46; P=0.18). However, there was a positive correlation noted with age at presentation and severity of AVN. Therefore, we advise close monitoring of hips in the Pavlik harness and discontinue its use if the hips are not reduced within 3 weeks.
LEVEL OF EVIDENCE: Level III.
Braces, Child, Preschool, Female, Femur Head, Femur Head Necrosis, Follow-Up Studies, Hip Dislocation, Congenital, Humans, Incidence, Infant, Male, Orthopedic Procedures, Patient Positioning, Prospective Studies, Risk Factors, Treatment Failure, Ultrasonography, United Kingdom, Journal Article
140-143
Tiruveedhula, Madhu
6c88610f-054a-445c-926e-12852accc454
Reading, Isabel C.
6f832276-87b7-4a76-a9ed-b4b3df0a3f66
Clarke, Nicholas M.P.
76688c21-d51e-48fa-a84d-deec66baf8ac
March 2015
Tiruveedhula, Madhu
6c88610f-054a-445c-926e-12852accc454
Reading, Isabel C.
6f832276-87b7-4a76-a9ed-b4b3df0a3f66
Clarke, Nicholas M.P.
76688c21-d51e-48fa-a84d-deec66baf8ac
Tiruveedhula, Madhu, Reading, Isabel C. and Clarke, Nicholas M.P.
(2015)
Failed Pavlik harness treatment for DDH as a risk factor for avascular necrosis.
Journal of Pediatric Orthopaedics, 35 (2), .
(doi:10.1097/BPO.0000000000000236).
Abstract
BACKGROUND: Avascular necrosis (AVN) of the femoral head is an irreversible complication seen in the treatment of developmental dysplasia of hip (DDH) with the Pavlik harness. Its incidence is reported to be low after successful reduction of the hip but high if the hip is not concentrically relocated. We aim to investigate its incidence after failed Pavlik harness treatment.
METHODS: We prospectively followed up a group of children who failed Pavlik harness treatment for DDH treated at our institution by the senior author between 1988 and 2001 and compared their rates of AVN with a group of children who presented late and hence were treated surgically. AVN was graded as described by Kalamchi and MacEwen and only grade 2 to 4 AVN was considered significant and included in the analysis.
RESULTS: Thirty-seven hips were included in the failed Pavlik group (group 1) and 86 hips in the no Pavlik group (group 2). Ten hips in group 1 developed AVN (27%), whereas only 7 hips in group 2 (8%) developed AVN; the odds of developing AVN after failed Pavlik treatment was 4.7 (95% confidence interval, 1.3-14.1) (P=0.009) with a relative risk of 3.32 (range, 1.37 to 8.05).
CONCLUSIONS: There was no statistically significant association observed with duration of splintage and severity of AVN (Spearman's correlation, -0.46; P=0.18). However, there was a positive correlation noted with age at presentation and severity of AVN. Therefore, we advise close monitoring of hips in the Pavlik harness and discontinue its use if the hips are not reduced within 3 weeks.
LEVEL OF EVIDENCE: Level III.
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More information
Published date: March 2015
Keywords:
Braces, Child, Preschool, Female, Femur Head, Femur Head Necrosis, Follow-Up Studies, Hip Dislocation, Congenital, Humans, Incidence, Infant, Male, Orthopedic Procedures, Patient Positioning, Prospective Studies, Risk Factors, Treatment Failure, Ultrasonography, United Kingdom, Journal Article
Identifiers
Local EPrints ID: 421666
URI: http://eprints.soton.ac.uk/id/eprint/421666
ISSN: 0271-6798
PURE UUID: 30227fbc-f6a6-4818-8916-6c3cadf2b2e1
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Date deposited: 19 Jun 2018 16:30
Last modified: 16 Mar 2024 03:02
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Author:
Madhu Tiruveedhula
Author:
Isabel C. Reading
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