David Neal1, Terri Beckwith2, Adam Hines3, Wei Chun Lee4, Bekir Eray Kilinc5, ChanHee Jo2, Harry Kim2,6. 1. John Peter Smith Hospital, Fort Worth, TX, USA. 2. Texas Scottish Rite Hospital for Children, Dallas, TX, USA. 3. Irwin Army Community Hospital, Fort Riley, KS, USA. 4. Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. 5. Health Science University, Fatih Sultan Mehmet Training and Research Hospital, Orthopaedics, Istanbul, Turkey. 6. Orthopedic Surgery Department at UT Southwestern Medical Center, Dallas, TX, USA.
Abstract
OBJECTIVE: Although the Pavlik Harness (PH) is the most utilized treatment for developmental dysplasia of the hip (DDH), the ideal treatment protocol (frequency of clinic visits in the first month and daily wear duration) for Barlow + hips (reduced but dislocatable) has yet to be defined. METHODS: This study compared DDH patients with Barlow hips who were treated with 23 vs 24 h per day PH wear and weekly vs every other week visits. Clinical success was defined as a stable hip that did not require closed or open reduction, or the use of an abduction orthosis prior to achieving clinical stability. Radiographic success was based on the acetabular index at 2-year follow up. RESULTS: Sixty-five patients (75 hips/58 females) with Barlow hips had a mean age of presentation of 15 ± 12 days (range 4-70) and mean follow-up of 33 ± 17 months (range 6-90). There was no difference in clinical or radiographic success rate between 23 h vs 24 h wear groups (p > 0.99 both) or the Frequently vs Infrequent visit groups (p = 0.49 both). Overall clinical success rate was 97% (73/75 hips) and radiographic success rate at 2 years was 97% (58/60 hips). CONCLUSION: A strict, weekly clinic visit and 24-h PH regimen may not be necessary to obtain good clinical and radiographic outcomes in infants presenting <6 months of age with Barlow positive hips. LEVEL OF EVIDENCE: Therapeutic, Level III.
OBJECTIVE: Although the Pavlik Harness (PH) is the most utilized treatment for developmental dysplasia of the hip (DDH), the ideal treatment protocol (frequency of clinic visits in the first month and daily wear duration) for Barlow + hips (reduced but dislocatable) has yet to be defined. METHODS: This study compared DDH patients with Barlow hips who were treated with 23 vs 24 h per day PH wear and weekly vs every other week visits. Clinical success was defined as a stable hip that did not require closed or open reduction, or the use of an abduction orthosis prior to achieving clinical stability. Radiographic success was based on the acetabular index at 2-year follow up. RESULTS: Sixty-five patients (75 hips/58 females) with Barlow hips had a mean age of presentation of 15 ± 12 days (range 4-70) and mean follow-up of 33 ± 17 months (range 6-90). There was no difference in clinical or radiographic success rate between 23 h vs 24 h wear groups (p > 0.99 both) or the Frequently vs Infrequent visit groups (p = 0.49 both). Overall clinical success rate was 97% (73/75 hips) and radiographic success rate at 2 years was 97% (58/60 hips). CONCLUSION: A strict, weekly clinic visit and 24-h PH regimen may not be necessary to obtain good clinical and radiographic outcomes in infants presenting <6 months of age with Barlow positive hips. LEVEL OF EVIDENCE: Therapeutic, Level III.
Entities:
Keywords:
Barlow positive hip; DDH; Developmental dysplasia of the hip; Pavlik harness
Authors: Kerry Dwan; Jamie Kirkham; Robin W Paton; Emma Morley; Ashley William Newton; Daniel C Perry Journal: Cochrane Database Syst Rev Date: 2022-10-10