Difficult-to-Treat Ortolani-Positive Hip

Abstract

In 1994, we presented a series of 52 Ortolani-positive hips (group 1) with a success rate of reduction of 85%. Now, our protocol for treating Ortolani-positive hips has evolved to include serial orthopaedic office-based ultrasound in all patients and use of a hip abduction orthosis in hips remaining unstable after 3 weeks in a Pavlik harness. Three previous studies at major centers reported successful reduction in only 63% to 71%. In group 2, our current success rate of 93% exceeds that previously reported by us and is significantly greater than these 3 previous studies (all P < 0.006). Furthermore, our current treatment module has decreased our rate of open reduction from 10% in group 1 to 5% in group 2. LEVEL OF RELEVANCE: Therapeutic study, level 3.

Results of the Pavlik harness when treating Ortolani-positive hips: Predictors of failure and arthrographic findings

“…Ninety-three patients were identified, including patients who underwent an Ortolani-positive maneuver by a senior pediatric orthopedic surgeon and who were initially treated with a Pavlik harness. In clinical examination, a hip was classified as ‘Ortolani-positive’ if the femoral head resided outside the acetabulum at rest but could be reduced into the acetabulum using the Ortolani maneuver [ 4 , 14 ]. We excluded from this study patients with dislocable hips (Barlow-positive hips), neuromuscular disease, arthrogryposis, teratologic dislocation or non-reducible dislocation.…”

“…When treating a patient in whom the Pavlik harness is not achieving reduction and stabilization of the hip, the treating surgeon has to decide when to move to a more aggressive modality of treatment (arthrography followed by closed or open reduction), which has also been related to AVN [ 10 , 11 ]. Although most clinicians agree in discontinuing the harness when failure to stabilize the hip is observed after 3–4 weeks of treatment [ 2 , 4 , 12 , 13 ], it is still unclear as to the best moment to abandon the Pavlik harness or even if another modality of treatment should be the first choice in some cases.…”

Association between open or closed reduction and avascular necrosis in developmental dysplasia of the hip

“…[3,4] The Pavlik harness was subsequently applied in patients with DDH that was first diagnosed in infancy and achieved a success rate reaching 90%. [5,6] Despite efforts to recognize and treat all cases of DDH soon after birth, late presentations and failure of Pavlik harness treatment are unavoidable. Thus, further treatment such as closed or open reduction of the dislocated hip is necessary in these cases.…”

Developmental dysplasia of the hip: What has changed in the last 20 years?

“…If the dysplastic hip treated by Pavlik harness is successfully reduced and free of contracture but still unstable, it should be treated with a fixed abduction orthosis [80,102,103] . Different abduction braces were reported to be successful, including Plastazote and Ilfeld abduction orthoses [104][105][106] . A part-time use of an abduction brace orthosis between the age of 6 to 12 mo is an effective intervention to improve residual acetabular dysplasia.…”