OUTCOMES OF ULTRASOUND-MONITORED TREATMENT OF DIVELOPMENTAL DYSPLASIA OF THE HIP GRAF TYPE II
Introduction: The management of developmental dysplasia of the hips (DDH) type Graf IIa is still controversial. This study aims to examine the outcomes of ultrasound-monitored Pavlik harness treatment, as well as the effects of associated factors, such as gender, side of DDH, the age at the treatment start, and laterality on the treatment outcomes in different Graf type II subtypes.
Methods: A cohort retrospective investigation was performed on 88 ultrasound-screened infants or 125 hips diagnosed with Graf type II dysplasia during a six-month period at a single institution, the University Clinic for Orthopedic Surgery, Skopje. Subsequently, 47 infants (18 boys, 29 girls) or 73 hips who underwent Pavlik harness treatment with at least one follow-up throughout treatment monitoring were included in this study.
Results: The treatment success rate of the right DDH Graf type IIa (-) was higher (70.8%) compared to the rate of success (50%) in the treatment of left Graf type IIa (-) hips. The mean age of the infants at the treatment start in successfully treated Graf type IIa (-) hips was lower (9.12 ±2.27 weeks) compared to the age of the infants with treatment failure at the last follow-up (11.33 ±3.06 weeks), P= 0.04.
Conclusion: The age of treatment initiation and the side of DDH were the most relevant factors related to the treatment outcome. Infants with maturational deficit hips, Graf type IIa (-), should undergo early initiated, carefully guided, and monitored Pavlik harness treatment.
Kim NT, Yang HJ, Choi CW, Park MS, Sung KH. Radiographic follow-up after normal ultrasound screening of the hip in breech infants. J Pediatr Orthop. 2022;42(3):e262-5. doi: 10.1097/bpo.0000000000002046.
Husum HC, Thomsen JL, Kold S, Maimburg RD, Rahbek O. Referral criteria recognition of screeners in the Danish screening program for hip dysplasia. Dan Med J. 2022;69(2):A01210098.
Xu N, Xia B, Tao H, Sun K, Liu Q, Chen W, et al. Epidemiological investigation and ultrasonic diagnosis of developmental dysplasia of the hip in Chinese infants: A large multi-center cohort study. Medicine (Baltimore). 2022;101(2):e28320. doi: 10.1097/MD.0000000000028320.
Koob S, Garbe W, Bornemann R, Ploeger MM, Scheidt S, Gathen M, et al. Is prematurity a protective factor against developmental dysplasia of the hip? A retrospective analysis of 660 newborns. Ultraschall Med. 2022;43(2):177-80. English. doi: 10.1055/a-1161-8984.
Aroojis A, Anne RP, Li J, Schaeffer E, Kesavan TMA, Shah S, et al. Surveillance for Developmental Dysplasia of the Hip in India: Consensus Guidelines From the Pediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association. Indian Pediatr. 2022;59(8):626-35.
Schwend RM, Shaw BA, Segal LS. Evaluation and treatment of developmental hip dysplasia in the newborn and infant. Pediatr Clin North Am. 2014;61(6):1095-107. doi:10.1016/j.pcl.2014.08.008
Yu RX, Gunaseelan L, Malik AS, Arulchelvan A, Yue E, Siddiqua A, et al. Utility of clinical and ultrasonographic hip screening in neonates for developmental dysplasia of the hip. Cureus. 2021;13(10):e18516. doi: 10.7759/cureus.18516.
Puhan MA, Woolacott N, Kleijnen J, Steurer J. Observational studies on ultrasound screening for developmental dysplasia of the hip in newborns - a systematic review. Ultraschall Med. 2003;24(6):377-382. doi:10.1055/s-2003-45213.
Bilgili F, Sağlam Y, Göksan SB, Hürmeydan ÖM, Birişik F, Demirel M. Treatment of Graf Type IIa hip dysplasia: a cut-off value for decision making. Balkan Med J. 2018;35(6):427-30. doi: 10.4274/balkanmedj.2017.1150.
Liu B, Hu X, Li L, Gao S. Morphological development of the hip in normal infants under six months of age by the Graf ultrasound method. Front Pediatr. 2022;10:914545. doi: 10.3389/fped.2022.914545.
Graf R. Classification of hip joint dysplasia by means of sonography. Arch Orthop Trauma Surg. 1984;102(4):248-55. doi:10.1007/BF00436138.
Synder M, Harcke HT, Domzalski M. Role of ultrasound in the diagnosis and management of developmental dysplasia of the hip: an international perspective. Orthop Clin North Am. 2006;37(2):141-v. doi:10.1016/j.ocl.2005.11.002
Taylor IK, Burlile JF, O'Brien K, Schaeffer EK, Mulpuri K, Shea KG. Developmental dysplasia of the hip: an examination of care practices of pediatricians. J Pediatr. 2022;246:179-83.e2.
Omeroğlu H, Caylak R, Inan U, Köse N. Ultrasonographic Graf type IIa hip needs more consideration in newborn girls. J Child Orthop. 2013;7(2):95-8. doi:10.1007/s11832-012-0476-1
Kosar P, Ergun E, Gökharman FD, Turgut AT, Kosar U. Follow-up sonographic results for Graf type 2A hips: association with risk factors for developmental dysplasia of the hip and instability. J Ultrasound Med. 2011;30(5):677-83. doi:10.7863/jum.2011.30.5.677
Mureşan S, Mărginean MO, Voidăzan S, Vlasa I, Sîntean I. Musculoskeletal ultrasound: a useful tool for diagnosis of hip developmental dysplasia: One single-center experience. Medicine. 2019;98(2):e14081. doi: 10.1097/md.0000000000014081.
Kitoh H, Kawasumi M, Ishiguro N. Predictive factors for unsuccessful treatment of developmental dysplasia of the hip by the Pavlik harness. J Pediatr Orthop. 2009;29(6):552-7. doi:10.1097/BPO.0b013e3181b2f200
Atalar H, Sayli U, Yavuz OY, Uraş I, Dogruel H. Indicators of successful use of the Pavlik harness in infants with developmental dysplasia of the hip. Int Orthop. 2007;31(2):145-50. doi:10.1007/s00264-006-0097-8
Palocaren T, Rogers K, Haumont T, Grissom L, Thacker MM. High failure rate of the Pavlik harness in dislocated hips: is it bilaterality? J Pediatr Orthop. 2013;33(5):530-5. doi:10.1097/BPO.0b013e318287ffc6
Borowski A, Thawrani D, Grissom L, Littleton AG, Thacker MM. Bilaterally dislocated hips treated with the Pavlik harness are not at a higher risk for failure. J Pediatr Orthop. 2009;29(7):661-5. doi:10.1097/BPO.0b013e3181b528f8
Lussier EC, Lei WT, Sun YT, Chen HW, Chang TY,Chang CH. Newborn hip screenings at 4 to 8 weeks are optimal in predicting referral and treatment outcomes: a retrospective review. Open Journal of Pediatrics.2020;10(2):332-46. doi: 10.4236/ojped.2020.102034.
Ziegler CM, Ertl KM, Delius M, Foerster KM, Crispin A, Wagner F, et al. Clinical examination and patients' history are not suitable for neonatal hip screening. J Child Orthop. 2022;16(1):19-26.
Woodacre T, Ball T, Cox P. Epidemiology of developmental dysplasia of the hip within the UK: refining the risk factors. J Child Orthop. 2016;10(6):633-42. doi:10.1007/s11832-016-0798-5.
Dzoleva-Tolevska R, Poposka A, Georgieva D. Results of ultrasound screening of the hips in newborns and infants. Sanamed. 2012;7(2): 97–101.
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