Poorer radiological outcome after delayed diagnosis and treatment in human position in Fettweis plaster cast in 93 unstable hip joints type D, III and IV according to Graf

Abstract

PurposeIn this study the course of unstable hips after successful treatment with Fettweis plaster of Paris (POP) is examined. Special focus will be given to age at beginning of treatment and initial hip type.MethodsThe development of 93 unstable hips treated between November 2001 and April 2015 was examined. Inclusion criteria were: 1) unstable hips with successful treatment with Fettweis POP; 2) presence of two pelvic radiographs (12 to 24 months and 24 to 48 months). We analyzed: 1) the initial ultrasound hip type according to Graf; 2) the average age at first and second radiograph; 3) the Tönnis classification: normal findings (< 1 SD), slightly (1 SD to 2 SD) and severely dysplastic hips (> 2 SD).ResultsIn all, there were 14 hips type D, 41 hips type III and 38 hips type IV. Mean age of the first radiograph was 13.9 months and of the second 28.5 months. The first radiograph showed: (< 1 SD): 36, (1 SD to 2 SD): 34, (> 2 SD): 23 hips, the second radiograph: (< 1 SD): 33, (1 SD to 2 SD): 19, (> 2 SD): 30 hips. With subdivision at the start of treatment at age eight or fewer weeks 2/16 hips (12.5%) and with initiation of the treatment more than eight weeks 22/77 (26.0%) deteriorated. During the course between first and second radiograph a total of 35.7% of initial hip type D, 19.5% of type III and 23.7% of type IV deteriorated.ConclusionRadiograph controls after treatment with Fettweis POP show poorer outcome after delaying the start of treatment more than 8 weeks. These findings were independent of the initial ultrasound hip type. Regular radiograph controls of all hip types treated for unstable hips are justified to detect residual dysplasia.Level of evidence:IV

Mid-term Follow-Up after Closed Reduction in Developmental Dysplastic Hips

“…In our study, failure occurred more often in patients that were primarily treated elsewhere and were significantly older upon presentation at our institution. This is in accordance with another study that described the critical time for initial treatment to be 8 weeks of age at the most for optimal results [23]. Therefore, it has been shown that early detection of DDHs through a general screening and early treatment are preventive for a large proportion of subsequent extensive hip surgeries [24].…”

Can Medialization of Acetabular Rim Be a Prognostic Factor in Treatment of Developmental Dysplasia of Hip?

“…The authors recommend long-term follow-up of even the successfully treated cases to detect deterioration following initial normal radiographs. 16 However, one study, which included infants with dislocated irreducible (D/I) 59 hips, reported 56.3% rate of treatment success with Pavlik harness. They added that treatment was successful until 4 months, and no correlation between treatment success and treatment initiation age was found.…”

“…Early diagnosis and proper treatment affect the prognosis of DDH. 2,3,9,16,17 However, the optimal time of the treatment to achieve success is not clear. The common opinion is that starting the treatment before 7 weeks of age has a positive effect on the treatment duration and success.…”

“…Early diagnosis and proper treatment affect the prognosis of DDH 2,3,9,16,17 . However, the optimal time of the treatment to achieve success is not clear.…”

“…Another study showed that the rate of residual dysplasia was higher in infants in whom treatment initiation age was >8 weeks of age regardless of the initial US hip type (Graf type D, type III, type IV). The authors recommend long‐term follow‐up of even the successfully treated cases to detect deterioration following initial normal radiographs 16 . However, one study, which included infants with dislocated irreducible (D/I) 59 hips, reported 56.3% rate of treatment success with Pavlik harness.…”