Treatment for developmental dysplasia of the hip using the Pavlik harness

Abstract

We reviewed the medical records of 115 patients with 130 hips with developmental dysplasia with complete dislocation in the absence of a neuromuscular disorder, spontaneous reduction with a Pavlik harness, and a minimum of 14 years' follow-up. The mean age at the time of harness application was 4.8 months (1 to 12) and the mean time spent in the harness was 6.1 months (3 to 12). A total of 108 hips (83.1%) were treated with the harness alone and supplementary surgery for residual acetabular dysplasia, as defined by an acetabular index > 30 degrees , was performed in 22 hips (16.9%). An overall satisfactory outcome (Severin grade I or II) was achieved in 119 hips (91.5%) at a mean follow-up of 16 years (14 to 32) with a follow-up rate of 75%. Avascular necrosis of the femoral head was noted in 16 hips (12.3%), seven of which (44%) underwent supplementary surgery and nine (56%) of which were classified as satisfactory. The acetabular index was the most reliable predictor of residual acetabular dysplasia.

Developmental dysplasia of hip – An overview

“…Twenty-two hips required supplementary surgery for residual dysplasia, the choice of surgery depending on the state of joint and surgeon's preference. A satisfactory outcome (Severin classes I and II) was achieved in 119 patients [47] .…”

Osteonecrosis Complicating Developmental Dysplasia of the Hip Compromises Subsequent Acetabular Remodeling

“…Sibinski et al [19] noted that residual acetabular dysplasia was more common if DDH was complicated by osteonecrosis. Nakamura et al [14] reported on 130 hips with DDH. For patients who did not have osteonecrosis develop, 97% had Severin Grade I or II hips at 14 years, with only 44% Grade I or II hips in patients with osteonecrosis.…”

Errors of diagnosis and the initiation of conservative treatment in children with congenital hip dislocation

“…Поражение зон роста прок-симального отдела бедренной кости у ребенка вследствие ишемии или некроза в тазобедренном суставе приводит к укорочению шейки и конеч-ности в целом, многоплоскостным деформациям проксимального отдела бедра. Это обусловливает развитие раннего деформирующего артроза тазо-бедренного сустава и резко ухудшает прогноз за-болевания [3,5,25,36,38]. В наших наблюдениях основными причинами развития АНГБК при консервативном лечении детей с врожденным вывихом бедра являлись: -отсутствие предрепозиционной подготовки; -одномоментные попытки закрытого вправле-ния бедра; -фиксация в ортопедической конструкции при избыточном отведении в тазобедренных су-ставах, близком к 90 градусам [37,39]; -длительная фиксация в ортопедических кон-струкциях при отсутствии вправления голов-ки бедра; -многократные попытки закрытого вправления бедра.…”

“…Важным аспектом проблемы являются вопро-сы дифференциальной диагностики заболевания, а именно раннее выявление вывихов бедра недис-пластической природы [38,42,43].…”