Known risk factors of the developmental dysplasia of the hip predicting more severe clinical presentation and failure of Pavlik harness treatment

Abstract

Purpose Developmental dysplasia of the hip (DDH) varies from mild instability of the hip to subluxation or total dislocation of the joint. Well-known risk factors of DDH include pre-natal breech position, female sex, positive family history, hip side, primiparity and the mode of delivery. Aim of the present study was to further evaluate known risk-factors of DDH, find associations with more severe dysplasia (characterized with Ortolani positivity) and find risk factors of failure of the Pavlik harness treatment. Material and methods All children with the diagnosis of DDH treated in Tampere University hospital in the years 1998–2018 were retrospectively identified for the study and the data was collected from the medical records. Teratological dislocations (n = 3) were excluded from the analysis. Total of 945 patients were included. Results Breech presentation was strongly associated with Ortolani positivity (p < 0.001). Breech presentation was not associated with ending up for spica casting and/or operative treatment (p = 0.291) despite the association with Ortolani positivity. Ortolani positivity (p = 0.002), positive family history (p = 0.013) and girl sex (p = 0.029) were associated with ending up for spica casting and/or operative treatment. Conclusion Breech presentation seems to increase the risk of Ortolani positive DDH. However, these infants are likely to recover with initially started Pavlik harness treatment, as it was not associated with elevated risk for undergoing more robust treatments. Positive family history and girl sex are associated with the most severe cases of developmental dysplasia of the hip, and it may predispose to the failure of the Pavlik harness treatment.

Positive family history and girl sex might increase the risk of failure of abduction treatment in developmental dysplasia of the hip

“…Same results were found with children with family history compared to children without family history. These ndings support our earlier ndings, where we found girl sex and family history to be risk for late recovery 24 and failure of the abduction treatment 21 . Our results in this study further explain the mechanism through which these risk factors effect on the recovery of DDH.…”

“…It seems that dislocation and irreducibility increase the risk of failure of the abduction treatment 9,12,18,19 , and some studies have also associated bilaterality with treatment failure 7,19,20 . In our earlier study we found, that girl sex and family history might predispose to treatment failure 21 .…”

Positive family history and girl sex might increase the risk of failure of abduction treatment in developmental dysplasia of the hip

“…Our results indicate that family history might predispose to more severe forms of DDH (characterized as low alpha angles and major hip instability at one month´s age). To our knowledge, there are no previous studies investigating the risk factors relation to the severity of DDH, despite our own previous study, where we found that girl sex and positive family history increase the risk of Ortolan positive DDH, and positive family history might increase the risk of casting and/or operation 21 . In our data it seemed, that positive family history was overrepresented among the children who failed the initial treatment (45% of the children who failed vs 22.3% of all children).…”

“…In our earlier study we have found, that girl sex and positive family history might increase the risk for late recovery 23 . Moreover, they seem to be risk factors for Ortolani positivity and might predispose to abduction treatment failure 21 . Several studies have found lower success rates of abduction treatment in more severe forms of DDH.…”

“…Some studies have also associated bilaterality with treatment failure 7,19,20 . In our earlier study we found that girl sex and family history might predispose to especially Ortolan positive and bilateral DDH, which might further predispose to treatment failure 21 .…”