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Management of irreducible hip dislocations in infants with developmental dysplasia of the hip diagnosed below 6 months of age

Management of irreducible hip dislocations in infants with developmental dysplasia of the hip diagnosed below 6 months of age
Management of irreducible hip dislocations in infants with developmental dysplasia of the hip diagnosed below 6 months of age

Background: Infants with dislocated irreducible (D/I) hips can be substantially harder to treat than infants with dislocated but reducible hips. The purpose of this study was to compare treatment methods and outcomes for infants with D/I hips in order to optimize management of this difficult patient cohort. Methods: A multicenter prospective hip dysplasia study database was analyzed from 2010 to 2016. Infants aged below 6 months with clinically and radiologically confirmed D/I hips were included in the study. Teratological hips (syndromic/neuromuscular) were excluded. Results: In total, 59 hips in 52 patients were included. All hips were clinically Ortolani negative and radiologically dislocated but irreducible on presentation and had at least 20 months of follow-up. Mean age at diagnosis was 1.9 months (range, 0.1 to 5.9 mo). There were 33 left hips, 12 right hips, and 14 bilateral hips (7 patients). In total, 48 of 59 hips were treated in Pavlik harness. The remainder were treated by alternative braces or primary closed or open reductions. Pavlik treatment was successful in 27 of 48 hips. Pavlik treatment was abandoned in 21 D/I hips, 3 due to femoral nerve palsy and the remainder due to failure to achieve reduction. There was no statistical correlation between Pavlik success and age at diagnosis (P=0.22), patient sex (P=0.61), or bilateral compared with unilateral D/I hips (P=0.07). Left hips were more likely to be successfully reduced in Pavlik harness than right hips (P=0.01). Five complications occurred: 3 patients developed femoral nerve palsy in Pavlik harness, while 2 patients developed avascular necrosis, both after failed Pavlik treatment and subsequent surgery. Conclusions: Pavlik harness treatment has been demonstrated to be a safe and sensible first-line treatment for infants with D/I hips. Left hips were more likely to be successfully reduced in Pavlik harness than right hips, but age, sex, and bilaterality were not correlated. The outcomes demonstrated from this multicentre prospective database inform management of this complex patient cohort. Level of Evidence: Level II-prognostic study: Less-quality prospective study.

developmental dysplasia of the hip, dislocation, infants, irreducible, multicenter, Pavlik harness, prospective database, reduction
0271-6798
e39-e43
Aarvold, Alex
11dc317f-47fd-4b2c-b0a6-78688c679b5a
Schaeffer, Emily K.
85523c03-d31e-47f6-a0a1-800de508ac58
Kelley, Simon
09eeeb7b-c0a5-43ce-86e0-9e692f156876
Clarke, Nicholas M.P.
76688c21-d51e-48fa-a84d-deec66baf8ac
Herrera-Soto, Jose A.
0ab1d894-fb57-4422-bae2-00120b97c5fa
Price, Charles T.
fb508c85-6d67-4b8e-8c0e-f0c964007d9c
Mulpuri, Kishore
3cf187f6-74b0-48bf-bcca-42351bead5c1
Aarvold, Alex
11dc317f-47fd-4b2c-b0a6-78688c679b5a
Schaeffer, Emily K.
85523c03-d31e-47f6-a0a1-800de508ac58
Kelley, Simon
09eeeb7b-c0a5-43ce-86e0-9e692f156876
Clarke, Nicholas M.P.
76688c21-d51e-48fa-a84d-deec66baf8ac
Herrera-Soto, Jose A.
0ab1d894-fb57-4422-bae2-00120b97c5fa
Price, Charles T.
fb508c85-6d67-4b8e-8c0e-f0c964007d9c
Mulpuri, Kishore
3cf187f6-74b0-48bf-bcca-42351bead5c1

Aarvold, Alex, Schaeffer, Emily K., Kelley, Simon, Clarke, Nicholas M.P., Herrera-Soto, Jose A., Price, Charles T. and Mulpuri, Kishore (2019) Management of irreducible hip dislocations in infants with developmental dysplasia of the hip diagnosed below 6 months of age. Journal of Pediatric Orthopaedics, 39 (1), e39-e43. (doi:10.1097/BPO.0000000000001205).

Record type: Article

Abstract

Background: Infants with dislocated irreducible (D/I) hips can be substantially harder to treat than infants with dislocated but reducible hips. The purpose of this study was to compare treatment methods and outcomes for infants with D/I hips in order to optimize management of this difficult patient cohort. Methods: A multicenter prospective hip dysplasia study database was analyzed from 2010 to 2016. Infants aged below 6 months with clinically and radiologically confirmed D/I hips were included in the study. Teratological hips (syndromic/neuromuscular) were excluded. Results: In total, 59 hips in 52 patients were included. All hips were clinically Ortolani negative and radiologically dislocated but irreducible on presentation and had at least 20 months of follow-up. Mean age at diagnosis was 1.9 months (range, 0.1 to 5.9 mo). There were 33 left hips, 12 right hips, and 14 bilateral hips (7 patients). In total, 48 of 59 hips were treated in Pavlik harness. The remainder were treated by alternative braces or primary closed or open reductions. Pavlik treatment was successful in 27 of 48 hips. Pavlik treatment was abandoned in 21 D/I hips, 3 due to femoral nerve palsy and the remainder due to failure to achieve reduction. There was no statistical correlation between Pavlik success and age at diagnosis (P=0.22), patient sex (P=0.61), or bilateral compared with unilateral D/I hips (P=0.07). Left hips were more likely to be successfully reduced in Pavlik harness than right hips (P=0.01). Five complications occurred: 3 patients developed femoral nerve palsy in Pavlik harness, while 2 patients developed avascular necrosis, both after failed Pavlik treatment and subsequent surgery. Conclusions: Pavlik harness treatment has been demonstrated to be a safe and sensible first-line treatment for infants with D/I hips. Left hips were more likely to be successfully reduced in Pavlik harness than right hips, but age, sex, and bilaterality were not correlated. The outcomes demonstrated from this multicentre prospective database inform management of this complex patient cohort. Level of Evidence: Level II-prognostic study: Less-quality prospective study.

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More information

Published date: 1 January 2019
Keywords: developmental dysplasia of the hip, dislocation, infants, irreducible, multicenter, Pavlik harness, prospective database, reduction

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Local EPrints ID: 427131
URI: https://eprints.soton.ac.uk/id/eprint/427131
ISSN: 0271-6798
PURE UUID: c6f581a7-99fe-4980-8256-6d6d807c756b

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Date deposited: 03 Jan 2019 17:30
Last modified: 03 Jan 2019 17:30

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Contributors

Author: Alex Aarvold
Author: Emily K. Schaeffer
Author: Simon Kelley
Author: Jose A. Herrera-Soto
Author: Charles T. Price
Author: Kishore Mulpuri

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