The efficacy of semirigid hip orthosis in the delayed treatment of developmental dysplasia of the hip

Uraş, İsmail; Yavuz, Osman Yüksel; Uygun, Murat; Yldrm, Hamdullah; Kömürcü, Mahmut

doi:10.1097/bpb.0000000000000052

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…As expected, Grades 1 and 2 were successfully reduced, which is consistent with our previous study based on a synthetic model (Ardila et al, 2013) as well as from clinical observation (Uras et al, 2014). Grade 3 was successfully reduced while Grade 4 dislocation was not.…”

Section: Discussionsupporting

confidence: 91%

“…Results provide insight of their contribution to reduction of DDH on severe Grade 3 and 4 dislocations whenever the PH is used and gravity is acting. It is known from clinical observation that reduction is successful whenever the PH is used on Grades 1 and 2 (Uras et al, 2014), thus these two grades were analyzed but values are not reported. Force and moment contribution of the adductor muscles while the PH is being used are reported for Grade 3 and Grade 4 (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…1b) is a standard non-surgical treatment for DDH (Ramsey et al, 1976;Weinstein et al, 2003) that is designed to maintain the hips in abduction and flexion to bring the femoral head back into the acetabulum (reduction). Clinical reports and previous research indicate very low success of the PH for more severe Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jbiomech www.JBiomech.com grades of hip dislocation (Ardila et al, 2013;Atalar et al, 2007;Uras et al, 2014). Also, the incidence of failure doubles when treatment begins after three weeks of age (Harding et al, 1997).…”

Section: Introductionmentioning

confidence: 96%

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A patient-specific model of the biomechanics of hip reduction for neonatal Developmental Dysplasia of the Hip: Investigation of strategies for low to severe grades of Developmental Dysplasia of the Hip

Huayamave

Rose

Serra

et al. 2015

Journal of Biomechanics

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A physics-based computational model of neonatal Developmental Dysplasia of the Hip (DDH) following treatment with the Pavlik Harness (PV) was developed to obtain muscle force contribution in order to elucidate biomechanical factors influencing the reduction of dislocated hips. Clinical observation suggests that reduction occurs in deep sleep involving passive muscle action. Consequently, a set of five (5) adductor muscles were identified as mediators of reduction using the PV. A Fung/Hill-type model was used to characterize muscle response. Four grades (1-4) of dislocation were considered, with one (1) being a low subluxation and four (4) a severe dislocation. A three-dimensional model of the pelvis-femur lower limb of a representative 10 week-old female was generated based on CT-scans with the aid of anthropomorphic scaling of anatomical landmarks. The model was calibrated to achieve equilibrium at 90° flexion and 80° abduction. The hip was computationally dislocated according to the grade under investigation, the femur was restrained to move in an envelope consistent with PV restraints, and the dynamic response under passive muscle action and the effect of gravity was resolved. Model results with an anteversion angle of 50° show successful reduction Grades 1-3, while Grade 4 failed to reduce with the PV. These results are consistent with a previous study based on a simplified anatomically-consistent synthetic model and clinical reports of very low success of the PV for Grade 4. However our model indicated that it is possible to achieve reduction of Grade 4 dislocation by hyperflexion and the resultant external rotation.

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Section: Discussionsupporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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A patient-specific model of the biomechanics of hip reduction for neonatal Developmental Dysplasia of the Hip: Investigation of strategies for low to severe grades of Developmental Dysplasia of the Hip

Huayamave

Rose

Serra

et al. 2015

Journal of Biomechanics

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“… 28 However, the PH is relatively complex to use and the reduced compliance of families with the use of the PH increases the rate of treatment failure. 24 , 29 Compared with the PH, the THFS is easier to use and families are more compliant with its use, which helps to explain the high rate of good clinical outcomes. 3 This is why the THFS has gained popularity among paediatric orthopaedic surgeons.…”

Section: Discussionmentioning

confidence: 99%

Tübingen hip flexion splint for the treatment of developmental dysplasia of the hip in children younger than six months age: A meta-analysis

Zhi

Xiao

Wan

et al. 2021

Journal of Children's Orthopaedics

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Purpose To investigate the success rate of the Tübingen hip flexion splint (THFS) for the treatment of developmental dysplasia of the hip (DDH), of different severity as per the Graf classification, among infants younger than six months of age. The type and incidence rate of complications associated with THFS treatment were also evaluated. Methods The following databases were searched using keywords and limited for age less than six months: PubMed, Embase, Web of Science, Cochrane Library, and SinoMed, between inception and July 2020. Articles were screened and extracted by two researchers, and the quality of the included literature was evaluated (methodological index for non-randomized studies criteria). R studio 1.3 was used for statistical analysis. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results After screening, eight articles were included in the analysis, contributing 1211 hips (875 patients). The overall success rate of THFS treatment is 91% (95% confidence interval (CI) 0.82 to 0.95). The success rate by Graf type is as follows: type-II, 98% (95% CI 0.94 to 1.00); type-III, 96% (95% CI 0.88 to 1.00); and type-IV, 32% (95% CI 0.18 to 0.47). Complications (24/1211, 2%) included transient femoral nerve palsy (n = 1); avascular necrosis of the femoral head (n = 9) and residual acetabular dysplasia (n = 14). Conclusion THFS treatment is successful for Graf type-II and –III, but low for type-IV, with a low rate of complication. THFS may be an effective treatment option for DDH among infants less than six months of age. However, those with Graf type-IV require close monitoring. Level of Evidence: III

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“…The literature has reported the use of some orthotic devices in treatment of the DDH, such as rigid and semirigid abduction braces, to replace the use of Pavlik harness and the spica cast (Dyskin and Ferrick, 2015;Hedequist et al, 2003;Ibrahim et al, 2013;Uras et al, 2014;Wahlen and Zambelli, 2015;Wilkinson et al, 2002). The use of an abduction brace is easier for the patient, parents and the physician.…”

Section: Introductionmentioning

confidence: 99%

A digital approach for design and fabrication by rapid prototyping of orthosis for developmental dysplasia of the hip

Munhoz

Moraes²,

Tanaka

et al. 2016

Res. Biomed. Eng.

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Introduction: Immobilization in a hip spica cast is required in surgical and nonsurgical treatments for children aged three months to four years diagnosed with developmental dysplasia of the hip. Skin complications are associated with the use of the spica cast in 30% of the cases. This research explores the use of photogrammetry and rapid prototyping for the production of a lighter, shower friendly and hygienic hip orthosis that could replace the hip spica cast. Methods: Digitalized data of a plastic dool was used for design and fabrication of a customised hip orthosis following four steps: 1) Digitalization of the external anatomical structure by photogrammetry using a smartphone and open source software; 2) Idealization and 3D modeling of the hip orthosis; 3) Rapid prototyping of a low cost orthosis in polymer polylact acid; 4) Evaluation tests. Results: Photogrammetry provided a good 3D reconstruction of the dool's hip and legs. The manufacture method to produce the hip orthosis was accurate in fitting the hip orthosis to the contours of the doll. The orthosis could be easily placed on the doll ensuring mechanical strength to immobilize the region of the hip. Conclusion: A new approach and the feasibility of both techniques for hip orthosis fabrication were described. It represents an exciting advance for the development of hip orthosis that could be used in orthopedics. To test the effectiveness of this orthosis for developmental dysplasia of the hip treatment in newborns, material and mechanical tests, design optimization and physical tests with patients should be carried.

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The efficacy of semirigid hip orthosis in the delayed treatment of developmental dysplasia of the hip

Abstract: Level IV. Case series.

Cited by 5 publications

References 19 publications

A patient-specific model of the biomechanics of hip reduction for neonatal Developmental Dysplasia of the Hip: Investigation of strategies for low to severe grades of Developmental Dysplasia of the Hip

A patient-specific model of the biomechanics of hip reduction for neonatal Developmental Dysplasia of the Hip: Investigation of strategies for low to severe grades of Developmental Dysplasia of the Hip

Tübingen hip flexion splint for the treatment of developmental dysplasia of the hip in children younger than six months age: A meta-analysis

A digital approach for design and fabrication by rapid prototyping of orthosis for developmental dysplasia of the hip

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