Management of Irreducible Hip Dislocations in Infants With Developmental Dysplasia of the Hip Diagnosed Below 6 Months of Age

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.

Update on the management of infant and toddler developmental dysplasia of the hip

“…A concentric reduction normalises the joint forces, which stimulates remodelling and reorientation of the growing hip. 4,9,12,24,25…”

“…Interruptions to proximal femoral growth, and osteonecrosis of the femoral capital epiphysis presumably occur as a result of vascular damage to the proximal femur during hip reduction and stabilisation. 20,25,26 Care must be taken at each step of treatment to minimise the risk of iatrogenic injury.…”

Complex treatment of the first year of life children with hip joints dysplasia

“…Дисплазія кульшових суглобів (ДКС) є найбільш поширеною вадою розвитку, займає одне з провідних місць серед захворювань опорно-рухової системи. За даними вітчизняних вчених, частота ДКС останніми роками збільшилась з 5-20 до 100-200 випадків на 1000 новонароджених [1,5,6,9].…”

“…Труднощами характеризується й лікування ДКС, що супроводжується перинатальною патологією центральної нервової системи (ППЦНС), яка посилює децентрацію головки стегнової кістки, нестабільність у кульшовому суглобі з подальшою дислокацією. У зв'язку з цим та з урахуванням зростаючої останніми роками поширеності дисплазії сполучної тканини (ДСТ, 35-65%) та ППЦНС (60-80% у дітей 1-го року життя) [2,5,6], при лікуванні ДКС виникає необхідність у застосуванні лікувально-реабілітаційних комплексів (ЛРК), що включають позиційну терапію (ортопедичні заходи), лікувальну гімнастику, масаж, фізіотерапію [2,4,7].…”

The feasibility of ultrasound Graf method in screening infants and young children with congenital hip dysplasia and follow-up of treatment effect

“…However, X-rays are limited in infant disease screening due to insufficient resolution and radiation (3). Ultrasonography has been widely used and popularized in the early screening of infant diseases due to its advantages including easy operation, repeatability, and no radiation damage (4). Based on this, this study analyzed the value of ultrasound Graf method in the screening and follow-up of treatment effects in infants and young children with congenital hip dysplasia, so as to provide a reliable basis for clinical diagnosis and treatment.…”