Early treatment with the von Rosen splint for neonatal instability of the hip is safe regarding avascular necrosis of the femoral head

Abstract

Background and purpose — Avascular necrosis of the femoral head (AVN) is a complication in treatment of developmental dysplasia of the hip (DDH). We evaluated the risk of AVN after early treatment in the von Rosen splint and measured the diameter of the ossific nucleus at 1 year of age.Children and methods — All children born in Malmö, Sweden, undergo clinical screening for neonatal instability of the hip (NIH). We reviewed 1-year radiographs of all children treated early for NIH in our department from 2003 through 2010. The diameter of the ossific nucleus was measured, and signs of AVN were classified according to Kalamchi-MacEwen. Subsequent radiographs, taken for any reason, were reviewed and a local registry of diagnoses was used to identify subsequent AVN.Results — 229 of 586 children referred because of suspected NIH received early treatment (age ≤ 1 week) for NIH during the study period. 2 of the 229 treated children (0.9%, 95% CI: 0.1–3.1) had grade-1 AVN. Both had spontaneous resolution and were asymptomatic during the observation time (6 and 8 years). 466 children met the inclusion criteria for measurement of the ossific nucleus. Neonatally dislocated hips had significantly smaller ossific nuclei than neonatally stable hips: mean 9.4 mm (95% CI: 9.1–9.8) vs. 11.1 mm (95% CI: 10.9–11.3) at 1 year (p < 0.001).Interpretation — Early treatment with the von Rosen splint for NIH is safe regarding AVN. The ossification of the femoral head is slower in children with NIH than in untreated children with neonatally stable hips.

Incidence of Late-Diagnosed Hip Dislocation After Universal Clinical Screening in Sweden

“…29 The best outcome may be expected if treatment is started during the neonatal period, when the risk of avascular necrosis is low. 7,30,31,32…”

“…29 The best outcome may be expected if treatment is started during the neonatal period, when the risk of avascular necrosis is low. 7,[30][31][32] Two previous studies 12,13 have evaluated universal ultrasonographic screening programs on a nationwide scale. In Germany, the rate of surgical procedures for DDH has been reduced from a historic minimum rate of 1 per 1000 live births to 0.26 per 1000 live births since the introduction of a screening program based on ultrasonographic examinations.…”

“…After this seemingly small delay, 46 infants (7.3%) needed subsequent surgery and 5 (0.8%) were not walking by 2 years of age . The best outcome may be expected if treatment is started during the neonatal period, when the risk of avascular necrosis is low …”

6 compared with 12 weeks treatment in the von Rosen splint is sufficient for Barlow and Ortolani positive hips: a comparative study of 237 neonates

“…Results with the von Rosen splint have been reported to be superior to other splints in treatment of newborns [ 11 ], and the treatment is safe with regards to AVN, which is why we have continued to use this method for more than 60 years [ 12 ]. In 2006 Lauge-Pedersen et al [ 5 ] published a retrospective study concluding that 6 weeks of treatment with the von Rosen splint is sufficient to treat DDH in newborns.…”

Clinical and Radiographic Alterations in Bilateral Avascular Necrosis of the Femoral Head Following Laser Acupuncture: A Case Report

“…Although patients are initially asymptomatic, AVN of the femoral head usually progresses to joint destruction, requiring total hip replacement, usually before the fifth decade. 1,2 Although radiography, scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI) have been widely used in the diagnosis of FHAVN, positron emission tomography (PET) has recently been evaluated to assess the vascularity of the femoral head. 3 Various treatments have been suggested for this pathologic condition including total hip arthroplasty, cell therapy with mesenchymal stromal cells, 4 trans-trochanteric rotational osteotomy, 5 using novel calcium phosphate (CPC) composite scaffold, which contains BMP-VEGFloaded poly-lactic-co-glycolic acid microspheres, 6 core decompression and autologous bone marrow concentrate, 3 and tensor fascia lata muscle pedicle grafting.…”