Diagnostic and treatment preferences for developmental dysplasia of the hip: A survey of EPOS and POSNA members

Aims When the present study was initiated, we changed the treatment for late-detected developmental dislocation of the hip (DDH) from several weeks of skin traction to markedly shorter traction time. The aim of this prospective study was to evaluate this change, with special emphasis on the rate of stable closed reduction according to patient age, the development of the acetabulum, and the outcome at skeletal maturity. Methods From 1996 to 2005, 49 children (52 hips) were treated for late-detected DDH. Their mean age was 13.3 months (3 to 33) at reduction. Prereduction skin traction was used for a mean of 11 days (0 to 27). Gentle closed reduction under general anaesthesia was attempted in all the hips. Concurrent pelvic osteotomy was not performed. The hips were evaluated at one, three and five years after reduction, at age eight to ten years, and at skeletal maturity. Mean age at the last follow-up was 15.7 years (13 to 21). Results Stable closed reduction was obtained in 36 hips (69%). Open reduction was more often necessary in patients ≥ 18 months of age at reduction (50%) compared with those under 18 months (24%). Residual hip dysplasia/subluxation occurred in 12 hips and was significantly associated with avascular necrosis (AVN) and with high acetabular index and low femoral head coverage the first years after reduction. Further surgery, mostly pelvic and femoral osteotomies to correct subluxation, was performed in eight hips (15%). The radiological outcome at skeletal maturity was satisfactory (Severin grades 1 or 2) in 43 hips (83%). Conclusions Gentle closed reduction can be attempted in children up to three years of age, but is likely to be less successful in children aged over 18 months. There is a marked trend to spontaneous improvement of the acetabulum after reduction, even in patients aged over 18 months and therefore simultaneous pelvic osteotomy is not always necessary.

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“… 5 A recent survey showed that 76% of POSNA members never used traction, indicating decreased use of traction during the last decades. 6 …”

Section: Introductionmentioning

confidence: 99%

Management of late-detected DDH in children under three years of age

Terjesen

Horn

2020

Bone & Joint Open

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“…The Pavlik harness is the most popular dynamic splint. Other dynamic splints used for treating DDH are the Tubingen splint, Frejka pillow, Von Rosen splint, Aberdeen splint, Coxaflex and Teufel brace [6][7][8][9][10][11][12]. The static splints promote a "rigid reduction".…”

Section: Introductionmentioning

confidence: 99%

Dynamic and Static Splinting for Treatment of Developmental Dysplasia of the Hip: A Systematic Review

et al. 2021

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Background: Developmental dysplasia of the hip (DDH) is one of the most common pediatric conditions. The current gold-standard treatment for children under six months of age with a reducible hip is bracing, but the orthopedic literature features several splint options, and each one has many advantages and disadvantages. The aim of this review is to analyze the available literature to document the up-to-date evidence on DDH conservative treatment. Methods: A systematic review of PubMed and Science Direct databases was performed by two independent authors (C.d.C. and A.V.) using the keywords “developmental dysplasia hip”, “brace”, “harness”, “splint”, “abduction brace” to evaluate studies of any level of evidence that reported clinical or preclinical results and dealt with conservative DDH treatment. The result of every stage was reviewed and approved by the senior investigators (V.P. and G.T.). Results: A total of 1411 articles were found. After the exclusion of duplicates, 367 articles were selected. At the end of the first screening, following the previously described selection criteria, we selected 29 articles eligible for full text reading. The included articles mainly focus on the Pavlik harness, Frejka, and Tubingen among the dynamic splint applications as well as the rhino-style brace, Ilfeld and generic abduction brace among the static splint applications. The main findings of the included articles were summarized. Conclusions: Dynamic splinting for DDH represents a valid therapeutic option in cases of instability and dislocation, especially if applied within 4–5 months of life. Dynamic splinting has a low contraindication. Static bracing is an effective option too, but only for stable hips or residual acetabular dysplasia.

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“…Despite substantial research, high-quality comparative studies continue to be lacking and the treatment of DDH is mainly based on the clinical experience of the treating surgeon [ 3 ]. This variability in opinion became evident in a 2018 survey of EPOS and POSNA members on their preferred treatment methods for DDH [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Conservative measures are more effective before the age of 6 months and include a variety of techniques such as the Pavlik harness splint [ 5 ], the Tubigen hip flexion splint [ 6 ], closed reduction plus spica casting and Sommerville- Petit method of traction [ 7 ]. According to the 2018 DDH survey, in spite of marked disparity between surgeons, closed reduction is usually not favored prior to 3 months or open reduction before 6 months of age [ 4 ]. Surgical Stabilization might be required in cases with failed conservative treatment, residual dysplasia or older children with neglected DDH.…”

Section: Introductionmentioning

confidence: 99%

The path to minimizing instability in developmental dysplasia of the hip: is Capsulorrhaphy a necessity or a futile habit?

Zargarbashi

Bozorgmanesh

Panjavi

et al. 2021

BMC Musculoskelet Disord

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Background To evaluate and quantify the intraoperative effect of capsulorrhaphy on the deep seating of femoral head within the acetabulum as measured by medial joint space, a surrogate measure of acetabular-head contact. Methods In order to determine the exact effect of capsulorrhaphy, we prospectively scrutinized a consecutive sample of 18 patients with unilateral dysplastic hips aging > 18 months and followed them for a period of at least 12 months. The procedure of open reduction is described in detail. Two pediatric orthopedists carried out the operations from August 2014 to January 2019 at a tertiary pediatric hospital. Intraoperatively, AP radiographs of the pelvis were obtained before and after capsulorrhaphy. The distance between the inferomedial edge of the proximal femoral metaphysis and the lateral edge of the obturator foramen was recorded. To determine if there were differences in medial joint space due to capsulorrhaphy, a generalized linear model was run on the study sample. All patients were followed for at least 12 months to determine the rate of re-dislocation. Results Mean age (±standard deviation) of the participants was 37.5 (±24.7) months. All cases underwent Salter osteotomy, 5 cases needed femoral shortening (27.8%) and none needed derotational osteotomy. Capsulorrhaphy lead to a statistically significant decrease in the mean medial joint space from 1.59 cm before (95% CI: 1.12–2.05) to 0.76 cm after (95% CI: 0.50–1.02) the capsulorrhaphy (P < 0.001). When we took the effect of age into account the corresponding figures were 1.47 (95% CI: 1.22–1.75) and 0.67 (95% CI: 0.39–0.94), respectively (P < 0.001). After follow up periods of 1 to 5.5 years, none of the patients experienced instability or re-dislocation. Conclusions Capsulorrhaphy, independently, of age was associated with a 1-cm decrease in the mean medial hip joint space and a more deeply seated femoral head. Furthermore, this study presents a successful experience with capsulorrhaphy to prevent hip instability.

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Diagnostic and treatment preferences for developmental dysplasia of the hip: A survey of EPOS and POSNA members

Cited by 46 publications

References 11 publications

Management of late-detected DDH in children under three years of age

Management of late-detected DDH in children under three years of age

Dynamic and Static Splinting for Treatment of Developmental Dysplasia of the Hip: A Systematic Review

The path to minimizing instability in developmental dysplasia of the hip: is Capsulorrhaphy a necessity or a futile habit?

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