Original article 339
The efficacy of semirigid hip orthosis in the delayed treatment of developmental dysplasia of the hip İsmail Uras¸, Osman Yu¨ksel Yavuz, Murat Uygun, Hamdullah Yıldırım and Mahmut Ko¨mu¨rcu¨ This study assessed the use of semirigid hip orthosis to stabilize the femoral head into the acetabulum in the delayed treatment of developmental dysplasia of the hip (DDH; Graf type IIb or more severe) under the age of 6 months. Ninety-eight hips from 75 patients (four boys, 71 girls) were evaluated retrospectively. The mean age at treatment initiation was 3.2 ± 1.3 months (1–6 months). As the dysplastic hip matured into a type I hip, we applied the weaning regimen for 1 month. Seventy-two patients (96%) were treated successfully in 4.2 ± 1.1 months (2–8 months). All of the failures were type IV hips. We did not detect any acetabular or femoral head pathology in the later follow-up. Semirigid hip orthosis is safe and effective as the first-line
Introduction The importance of early diagnosis and accurate treatment in cases of developmental dysplasia of the hip (DDH) is accepted as an indispensable factor in reducing the operation rate. The Pavlik harness is widely used as the initial treatment of DDH in patients under the age of 6 months. However, noncompliance of parents due to difficulty of applying the Pavlik harness has been observed [1,2]. Hedequist reported that after failure of Pavlik harness treatment, patients were treated successfully with rigid hip orthosis [3]. We applied a semirigid hip orthosis for the early and delayed treatment of DDH in infants under 6 months of age. The aim of the present study was to assess the use of semirigid hip orthosis as the initial treatment for DDH.
Materials and methods The study group included type IIb or worse hips detected by the universal DDH screening programme at the hospital or referred from other institutions between January 2006 and January 2012. Seventy-five patients (four boys, 71 girls) out of 77 who were contacted were included in the study. Ninety-eight hips from 75 patients were evaluated retrospectively. The mean age at treatment initiation was 3.2 ± 1.3 months (1–6 months). According to Rosendahl, eight patients had early treatment (before 5 weeks of age) and 67 patients had delayed treatment (after 5 weeks of age) [4]. The mean follow-up was 49.9 ± 27.9 months (12–86 months). Patients received semirigid hip orthosis (Tubinger Hip Flexion Orthosis; Otto Bock HealthCare GmbH, Duderstadt, Germany) within 2 days after the dysplasia 1060-152X © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
treatment method for delayed DDH except in type IV hips in patients under 6 months of age. Level of Evidence: Level IV. Case series. J Pediatr Orthop B 23:339–342 © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Journal of Pediatric Orthopaedics B 2014, 23:339–342 Keywords: developmental dysplasia of the hip, orthosis, treatment Orthopaedics and Traumatology Department, Faculty of Medicine, Turgut Özal University, Ankara, Turkey Correspondence to İsmail Uraş, MD, Alparslan Turkes Bulvarı No: 57, 06510 Emek, Ankara, Turkey Tel: + 90 312 203 55 55; fax: + 90 312 221 36 70; e-mail: [email protected]
was confirmed by ultrasonography (Fig. 1). The hips were followed up fortnightly using ultrasonography. As we determined that a dysplastic hip had matured into type I hip (α angle ≥ 60° and sufficient femoral head coverage), we switched to the weaning regimen (Fig. 2). This regimen consisted of the use of the orthosis while sleeping for 1 month. At the end of the treatment, we obtained pelvic radiographs and assessed the patients for any residual dysplasia or avascular necrosis. We performed follow-up of the patients with pelvic radiographs at 1 year of age and at walking age. We continued to follow-up with yearly serial pelvic radiographs. The exclusion criteria were as follows: patients with teratological DDH, patients with neuromuscular disorders, patients with connective tissue disorders and interruption of the treatment due to life-threatening illness. We used the SPSS programme for statistical analysis (SPSS 13.0; SPSS Inc., Chicago, Illinois, USA). Furthermore, we used the χ2-test for evaluation of the treatment results.
Results We analysed 98 hips from 75 patients (23 bilateral, 30.6%) retrospectively. Forty-six patients (61.3%) were first-born children. Eight patients (10.6%) had a family history of DDH. Thirteen patients (17.3%) were breech presentation. The mean birth weight was 3372 ± 613 g (2150–4300), and the average gestational age at delivery was 38.7 ± 1.5 weeks (36–40 weeks). The left hip was affected in 56 patients (74.6%) and the right in 42 patients (56%). DOI: 10.1097/BPB.0000000000000052
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
340
Journal of Pediatric Orthopaedics B 2014, Vol 23 No 4
Fig. 1
Tubinger hip flexion orthosis (anterior and posterior view).
Fig. 2
Type IV hip at the initiation of treatment, at the femoral head reduction and at the end of the treatment.
At the time of presentation, 46 of the hips (46.9%) were type IIb, 28 (37.3%) were type IIc, 10 (10.2%) were type D, nine (9.1%) were type III and five (5.1%) were type IV as determined using the Graf
method (Fig. 3). The Ortolani test was positive in 11 hips. Limitation of hip abduction was present in 52 hips. Physical examination showed that 35 hips were normal.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Efficacy of semirigid hip orthosis Uraş et al. 341
Count
Fig. 3
Fig. 4
50 45 40 35 30 25 20 15 10 5 0 Type llb
Type llc
Type D
Type lll
Type lV
Graf type Success
Failure
The effects of Graf type on the treatment results.
The age at initiation of treatment ranged between 1 and 6 months (3.2 ± 1.4 months). The average duration of treatment was 4.2 ± 1.1 months (2–8 months). The mean follow-up time was 49.9 ± 27.9 months (12–86 months). We continued the treatment with Dennis-Brown orthosis due to the advanced age of the patient in five cases out of 72 patients, who were treated successfully. All patients in the early treatment group (10 hips from eight patients) were treated successfully (three type IIc, three type D, three type III and one type IV). Treatment of three patients in the delayed treatment group failed. All of these were type IV (three of the five patients), and only limitation of hip abduction was present on their physical examination. Treatment results for type IV hips were statistically significantly different from those for type II and type III hips (P < 0.001). The remaining 85 hips from 64 patients (46 type IIb, 25 type IIc, seven type D, six type III and four type IV) were treated successfully in the delayed treatment group. Patients treated successfully did not require further treatment such as casting or acetabular osteotomy. One patient had transient femoral nerve palsy. Avascular necrosis was not determined in the femoral heads. We did not detect any femoral head pathology in the later follow-up. The mean acetabular index was 29.3 ± 3.1° (24–37°) at 1 year of age (Fig. 4). We did not detect any residual acetabular dysplasia at walking age.
Discussion The success rate using the Pavlik harness is reported to be between 80 and 97% [5–8]. However, noncompliance of parents due to difficulties in applying the Pavlik harness results in avascular necrosis [9], treatment failure [10], brachial plexus lesions [11], femoral nerve damage [10] and complex hip deformation [12]. Hedequist et al. [3] used an abduction brace successfully for the treatment of DDH after failure of the Pavlik harness. Moreover,
Radiographic image of the hips at 1 year of age and at 2 years of age.
Wilkinson et al. [13] reported better results with rigid abduction splints than with the Pavlik harness in severe DDH hips. We also observed that the Pavlik harness failed to treat type IV hips [2]. Conversely, Ibrahim et al. [14] reported that subsequent abduction bracing provided no benefit after failure of the Pavlik harness. Finally, Graf advised rigid abduction orthosis for the retention and the maturity phases of DDH treatment [15]. We decided to use semirigid hip orthosis for the first-line treatment of early and delayed DDH to stabilize the femoral head into the acetabulum more successfully. In the current patient group, a successful outcome was obtained in 96% of the patients with semirigid hip orthosis. As we had no control group, the successful result cannot be connected to semirigid hip orthosis itself. We believe that the success of the treatment was associated with the high proportion of type II dysplasia in the patient group. In the early treatment group, the success rate was 100%, whereas in the delayed treatment group, the success rate was 95.5%. There was no statistically significant difference between these groups. In accordance with these results, Brurås et al. observed no difference between the early and the late treatment groups [16]. We had a success rate of 58% with the Pavlik harness in our previous study [2], and explained the lower success rate as resulting from noncompliance of the parents with the Pavlik harness.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
342 Journal of Pediatric Orthopaedics B 2014, Vol 23 No 4
All failures were type IV hips. In contrast, we were successful in two out of five type IV hips. Both of the hips reduced with rigid hip orthosis were Ortolani positive. We had no success with the Pavlik harness in type IV hips in our previous study [2]. Ardila et al. [17] suggested an alternative method of treatment to the Pavlik harness for hip dysplasia of greater severity (type IV) based on their biomechanical study. Thus, the Pavlik harness may not be the appropriate method of treatment for type IV dysplastic hips [17]. Two hips did not show any improvement (femoral head reduction) with rigid hip orthosis after 2 weeks and were treated with closed reduction and hip spica casts under general anaesthesia. One patient exhibited improvement with rigid hip orthosis (femoral head reduction), but the development of the hip plateaued at 2 months. This patient’s parents did not accept closed reduction under general anaesthesia. Avascular necrosis rates in DDH are generally reported to be between 0 and 33% [2,8,9,18,19]. We did not detect any avascular necrosis in femoral heads other than ossification delay. Moreover, we did not detect any femoral head pathology on the pelvic radiographs obtained at 2 years of age. Semirigid hip orthosis is safe and effective as the first-line treatment method for DDH except in type IV hips in patients under 6 months of age. Although it is obvious that closed reduction and plaster treatment are more effective than semirigid hip orthosis treatment in type IV hips, this involves disadvantages such as increased cost, complications from general anaesthesia, the long-term use of plaster casts and radiation exposure due to reduction control with computed tomography. We think that semirigid hip orthosis should be attempted for the reduction of the femoral head in type IV hips at the beginning of the treatment to avoid the disadvantages of closed reduction.
References 1
2
3
4
5
6
7
8 9
10
11 12
13
14
15 16
17
18
Acknowledgements Conflicts of interest
None of the authors received financial support for this study. There are no conflicts of interest.
19
Hassan FA. Compliance of parents with regard to Pavlik harness treatment in developmental dysplasia of the hip. J Pediatr Orthop B 2009; 18:111–115. 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; 31:145–150. Hedequist D, Kasser J, Emans J. Use of an abduction brace for developmental dysplasia of the hip after failure of Pavlik harness use. J Pediatr Orthop 2003; 23:175–177. Bergo KK, Rosendahl K. Parent satisfaction with early and delayed abduction splinting therapy of developmental hip dysplasia. Acta Paediatr 2013; 102:e339–e343. Lerman JA, Emans JB, Millis MB, Share J, Zurakowski D, Kasser JR. Early failure of Pavlik harness treatment for developmental hip dysplasia: clinical and ultrasound predictors. J Pediatr Orthop 2001; 21:348–353. Mostert AK, Tulp NJ, Castelein RM. Results of Pavlik harness treatment for neonatal hip dislocation as related to Graf’s sonographic classification. J Pediatr Orthop 2000; 20:306–310. Uçar DH, Işiklar ZU, Kandemir U, Tümer Y. Treatment of developmental dysplasia of the hip with Pavlik harness: prospective study in Graf type IIc or more severe hips. J Pediatr Orthop B 2004; 13:70–74. Tibrewal S, Gulati V, Ramachandran M. The Pavlik method: a systematic review of current concepts. J Pediatr Orthop B 2013; 22:516–520. Suzuki S, Kashiwagi N, Kasahara Y, Seto Y, Futami T. Avascular necrosis and the Pavlik harness. The incidence of avascular necrosis in three types of congenital dislocation of the hip as classified by ultrasound. J Bone Joint Surg Br 1996; 78:631–635. Viere RG, Birch JG, Herring JA, Roach JW, Johnston CE. Use of the Pavlik harness in congenital dislocation of the hip. An analysis of failures of treatment. J Bone Joint Surg Am 1990; 72:238–244. Suzuki S. Ultrasound and the Pavlik harness in CDH. J Bone Joint Surg Br 1993; 75:483–487. Jones GT, Schoenecker PL, Dias LS. Developmental hip dysplasia potentiated by inappropriate use of the Pavlik harness. J Pediatr Orthop 1992; 12:722–726. Wilkinson AG, Sherlock DA, Murray GD. The efficacy of the Pavlik harness, the Craig splint and the von Rosen splint in the management of neonatal dysplasia of the hip. A comparative study. J Bone Joint Surg Br 2002; 84:716–719. Ibrahim DA, Skaggs DL, Choi PD. Abduction bracing after Pavlik harness failure: an effective alternative to closed reduction and spica casting? J Pediatr Orthop 2013; 33:536–539. Graf R. Hip sonography. Berlin Heidelberg: Springer-Verlag; 2006. Brurås KR, Aukland SM, Markestad T, Sera F, Dezateux C, Rosendahl K. Newborns with sonographically dysplastic and potentially unstable hips: 6-year follow-up of an RCT. Pediatrics 2011; 127:e661–e666. Ardila OJ, Divo EA, Moslehy FA, Rab GT, Kassab AJ, Price CT. Mechanics of hip dysplasia reductions in infants using the Pavlik harness: a physicsbased computational model. J Biomech 2013; 46:1501–1507. Iwasaki K. Treatment of congenital dislocation of the hip by the Pavlik harness. Mechanism of reduction and usage. J Bone Joint Surg Am 1983; 65:760–767. Ramsey PL, Lasser S, MacEwen GD. Congenital dislocation of the hip. Use of the Pavlik harness in the child during the first six months of life. J Bone Joint Surg Am 1976; 58:1000–1004.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
The efficacy of semirigid hip orthosis in the delayed treatment of developmental dysplasia of the hip İsmail Uras¸, Osman Yu¨ksel Yavuz, Murat Uygun, Hamdullah Yıldırım and Mahmut Ko¨mu¨rcu¨ This study assessed the use of semirigid hip orthosis to stabilize the femoral head into the acetabulum in the delayed treatment of developmental dysplasia of the hip (DDH; Graf type IIb or more severe) under the age of 6 months. Ninety-eight hips from 75 patients (four boys, 71 girls) were evaluated retrospectively. The mean age at treatment initiation was 3.2 ± 1.3 months (1–6 months). As the dysplastic hip matured into a type I hip, we applied the weaning regimen for 1 month. Seventy-two patients (96%) were treated successfully in 4.2 ± 1.1 months (2–8 months). All of the failures were type IV hips. We did not detect any acetabular or femoral head pathology in the later follow-up. Semirigid hip orthosis is safe and effective as the first-line
Introduction The importance of early diagnosis and accurate treatment in cases of developmental dysplasia of the hip (DDH) is accepted as an indispensable factor in reducing the operation rate. The Pavlik harness is widely used as the initial treatment of DDH in patients under the age of 6 months. However, noncompliance of parents due to difficulty of applying the Pavlik harness has been observed [1,2]. Hedequist reported that after failure of Pavlik harness treatment, patients were treated successfully with rigid hip orthosis [3]. We applied a semirigid hip orthosis for the early and delayed treatment of DDH in infants under 6 months of age. The aim of the present study was to assess the use of semirigid hip orthosis as the initial treatment for DDH.
Materials and methods The study group included type IIb or worse hips detected by the universal DDH screening programme at the hospital or referred from other institutions between January 2006 and January 2012. Seventy-five patients (four boys, 71 girls) out of 77 who were contacted were included in the study. Ninety-eight hips from 75 patients were evaluated retrospectively. The mean age at treatment initiation was 3.2 ± 1.3 months (1–6 months). According to Rosendahl, eight patients had early treatment (before 5 weeks of age) and 67 patients had delayed treatment (after 5 weeks of age) [4]. The mean follow-up was 49.9 ± 27.9 months (12–86 months). Patients received semirigid hip orthosis (Tubinger Hip Flexion Orthosis; Otto Bock HealthCare GmbH, Duderstadt, Germany) within 2 days after the dysplasia 1060-152X © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
treatment method for delayed DDH except in type IV hips in patients under 6 months of age. Level of Evidence: Level IV. Case series. J Pediatr Orthop B 23:339–342 © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Journal of Pediatric Orthopaedics B 2014, 23:339–342 Keywords: developmental dysplasia of the hip, orthosis, treatment Orthopaedics and Traumatology Department, Faculty of Medicine, Turgut Özal University, Ankara, Turkey Correspondence to İsmail Uraş, MD, Alparslan Turkes Bulvarı No: 57, 06510 Emek, Ankara, Turkey Tel: + 90 312 203 55 55; fax: + 90 312 221 36 70; e-mail: [email protected]
was confirmed by ultrasonography (Fig. 1). The hips were followed up fortnightly using ultrasonography. As we determined that a dysplastic hip had matured into type I hip (α angle ≥ 60° and sufficient femoral head coverage), we switched to the weaning regimen (Fig. 2). This regimen consisted of the use of the orthosis while sleeping for 1 month. At the end of the treatment, we obtained pelvic radiographs and assessed the patients for any residual dysplasia or avascular necrosis. We performed follow-up of the patients with pelvic radiographs at 1 year of age and at walking age. We continued to follow-up with yearly serial pelvic radiographs. The exclusion criteria were as follows: patients with teratological DDH, patients with neuromuscular disorders, patients with connective tissue disorders and interruption of the treatment due to life-threatening illness. We used the SPSS programme for statistical analysis (SPSS 13.0; SPSS Inc., Chicago, Illinois, USA). Furthermore, we used the χ2-test for evaluation of the treatment results.
Results We analysed 98 hips from 75 patients (23 bilateral, 30.6%) retrospectively. Forty-six patients (61.3%) were first-born children. Eight patients (10.6%) had a family history of DDH. Thirteen patients (17.3%) were breech presentation. The mean birth weight was 3372 ± 613 g (2150–4300), and the average gestational age at delivery was 38.7 ± 1.5 weeks (36–40 weeks). The left hip was affected in 56 patients (74.6%) and the right in 42 patients (56%). DOI: 10.1097/BPB.0000000000000052
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
340
Journal of Pediatric Orthopaedics B 2014, Vol 23 No 4
Fig. 1
Tubinger hip flexion orthosis (anterior and posterior view).
Fig. 2
Type IV hip at the initiation of treatment, at the femoral head reduction and at the end of the treatment.
At the time of presentation, 46 of the hips (46.9%) were type IIb, 28 (37.3%) were type IIc, 10 (10.2%) were type D, nine (9.1%) were type III and five (5.1%) were type IV as determined using the Graf
method (Fig. 3). The Ortolani test was positive in 11 hips. Limitation of hip abduction was present in 52 hips. Physical examination showed that 35 hips were normal.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Efficacy of semirigid hip orthosis Uraş et al. 341
Count
Fig. 3
Fig. 4
50 45 40 35 30 25 20 15 10 5 0 Type llb
Type llc
Type D
Type lll
Type lV
Graf type Success
Failure
The effects of Graf type on the treatment results.
The age at initiation of treatment ranged between 1 and 6 months (3.2 ± 1.4 months). The average duration of treatment was 4.2 ± 1.1 months (2–8 months). The mean follow-up time was 49.9 ± 27.9 months (12–86 months). We continued the treatment with Dennis-Brown orthosis due to the advanced age of the patient in five cases out of 72 patients, who were treated successfully. All patients in the early treatment group (10 hips from eight patients) were treated successfully (three type IIc, three type D, three type III and one type IV). Treatment of three patients in the delayed treatment group failed. All of these were type IV (three of the five patients), and only limitation of hip abduction was present on their physical examination. Treatment results for type IV hips were statistically significantly different from those for type II and type III hips (P < 0.001). The remaining 85 hips from 64 patients (46 type IIb, 25 type IIc, seven type D, six type III and four type IV) were treated successfully in the delayed treatment group. Patients treated successfully did not require further treatment such as casting or acetabular osteotomy. One patient had transient femoral nerve palsy. Avascular necrosis was not determined in the femoral heads. We did not detect any femoral head pathology in the later follow-up. The mean acetabular index was 29.3 ± 3.1° (24–37°) at 1 year of age (Fig. 4). We did not detect any residual acetabular dysplasia at walking age.
Discussion The success rate using the Pavlik harness is reported to be between 80 and 97% [5–8]. However, noncompliance of parents due to difficulties in applying the Pavlik harness results in avascular necrosis [9], treatment failure [10], brachial plexus lesions [11], femoral nerve damage [10] and complex hip deformation [12]. Hedequist et al. [3] used an abduction brace successfully for the treatment of DDH after failure of the Pavlik harness. Moreover,
Radiographic image of the hips at 1 year of age and at 2 years of age.
Wilkinson et al. [13] reported better results with rigid abduction splints than with the Pavlik harness in severe DDH hips. We also observed that the Pavlik harness failed to treat type IV hips [2]. Conversely, Ibrahim et al. [14] reported that subsequent abduction bracing provided no benefit after failure of the Pavlik harness. Finally, Graf advised rigid abduction orthosis for the retention and the maturity phases of DDH treatment [15]. We decided to use semirigid hip orthosis for the first-line treatment of early and delayed DDH to stabilize the femoral head into the acetabulum more successfully. In the current patient group, a successful outcome was obtained in 96% of the patients with semirigid hip orthosis. As we had no control group, the successful result cannot be connected to semirigid hip orthosis itself. We believe that the success of the treatment was associated with the high proportion of type II dysplasia in the patient group. In the early treatment group, the success rate was 100%, whereas in the delayed treatment group, the success rate was 95.5%. There was no statistically significant difference between these groups. In accordance with these results, Brurås et al. observed no difference between the early and the late treatment groups [16]. We had a success rate of 58% with the Pavlik harness in our previous study [2], and explained the lower success rate as resulting from noncompliance of the parents with the Pavlik harness.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
342 Journal of Pediatric Orthopaedics B 2014, Vol 23 No 4
All failures were type IV hips. In contrast, we were successful in two out of five type IV hips. Both of the hips reduced with rigid hip orthosis were Ortolani positive. We had no success with the Pavlik harness in type IV hips in our previous study [2]. Ardila et al. [17] suggested an alternative method of treatment to the Pavlik harness for hip dysplasia of greater severity (type IV) based on their biomechanical study. Thus, the Pavlik harness may not be the appropriate method of treatment for type IV dysplastic hips [17]. Two hips did not show any improvement (femoral head reduction) with rigid hip orthosis after 2 weeks and were treated with closed reduction and hip spica casts under general anaesthesia. One patient exhibited improvement with rigid hip orthosis (femoral head reduction), but the development of the hip plateaued at 2 months. This patient’s parents did not accept closed reduction under general anaesthesia. Avascular necrosis rates in DDH are generally reported to be between 0 and 33% [2,8,9,18,19]. We did not detect any avascular necrosis in femoral heads other than ossification delay. Moreover, we did not detect any femoral head pathology on the pelvic radiographs obtained at 2 years of age. Semirigid hip orthosis is safe and effective as the first-line treatment method for DDH except in type IV hips in patients under 6 months of age. Although it is obvious that closed reduction and plaster treatment are more effective than semirigid hip orthosis treatment in type IV hips, this involves disadvantages such as increased cost, complications from general anaesthesia, the long-term use of plaster casts and radiation exposure due to reduction control with computed tomography. We think that semirigid hip orthosis should be attempted for the reduction of the femoral head in type IV hips at the beginning of the treatment to avoid the disadvantages of closed reduction.
References 1
2
3
4
5
6
7
8 9
10
11 12
13
14
15 16
17
18
Acknowledgements Conflicts of interest
None of the authors received financial support for this study. There are no conflicts of interest.
19
Hassan FA. Compliance of parents with regard to Pavlik harness treatment in developmental dysplasia of the hip. J Pediatr Orthop B 2009; 18:111–115. 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; 31:145–150. Hedequist D, Kasser J, Emans J. Use of an abduction brace for developmental dysplasia of the hip after failure of Pavlik harness use. J Pediatr Orthop 2003; 23:175–177. Bergo KK, Rosendahl K. Parent satisfaction with early and delayed abduction splinting therapy of developmental hip dysplasia. Acta Paediatr 2013; 102:e339–e343. Lerman JA, Emans JB, Millis MB, Share J, Zurakowski D, Kasser JR. Early failure of Pavlik harness treatment for developmental hip dysplasia: clinical and ultrasound predictors. J Pediatr Orthop 2001; 21:348–353. Mostert AK, Tulp NJ, Castelein RM. Results of Pavlik harness treatment for neonatal hip dislocation as related to Graf’s sonographic classification. J Pediatr Orthop 2000; 20:306–310. Uçar DH, Işiklar ZU, Kandemir U, Tümer Y. Treatment of developmental dysplasia of the hip with Pavlik harness: prospective study in Graf type IIc or more severe hips. J Pediatr Orthop B 2004; 13:70–74. Tibrewal S, Gulati V, Ramachandran M. The Pavlik method: a systematic review of current concepts. J Pediatr Orthop B 2013; 22:516–520. Suzuki S, Kashiwagi N, Kasahara Y, Seto Y, Futami T. Avascular necrosis and the Pavlik harness. The incidence of avascular necrosis in three types of congenital dislocation of the hip as classified by ultrasound. J Bone Joint Surg Br 1996; 78:631–635. Viere RG, Birch JG, Herring JA, Roach JW, Johnston CE. Use of the Pavlik harness in congenital dislocation of the hip. An analysis of failures of treatment. J Bone Joint Surg Am 1990; 72:238–244. Suzuki S. Ultrasound and the Pavlik harness in CDH. J Bone Joint Surg Br 1993; 75:483–487. Jones GT, Schoenecker PL, Dias LS. Developmental hip dysplasia potentiated by inappropriate use of the Pavlik harness. J Pediatr Orthop 1992; 12:722–726. Wilkinson AG, Sherlock DA, Murray GD. The efficacy of the Pavlik harness, the Craig splint and the von Rosen splint in the management of neonatal dysplasia of the hip. A comparative study. J Bone Joint Surg Br 2002; 84:716–719. Ibrahim DA, Skaggs DL, Choi PD. Abduction bracing after Pavlik harness failure: an effective alternative to closed reduction and spica casting? J Pediatr Orthop 2013; 33:536–539. Graf R. Hip sonography. Berlin Heidelberg: Springer-Verlag; 2006. Brurås KR, Aukland SM, Markestad T, Sera F, Dezateux C, Rosendahl K. Newborns with sonographically dysplastic and potentially unstable hips: 6-year follow-up of an RCT. Pediatrics 2011; 127:e661–e666. Ardila OJ, Divo EA, Moslehy FA, Rab GT, Kassab AJ, Price CT. Mechanics of hip dysplasia reductions in infants using the Pavlik harness: a physicsbased computational model. J Biomech 2013; 46:1501–1507. Iwasaki K. Treatment of congenital dislocation of the hip by the Pavlik harness. Mechanism of reduction and usage. J Bone Joint Surg Am 1983; 65:760–767. Ramsey PL, Lasser S, MacEwen GD. Congenital dislocation of the hip. Use of the Pavlik harness in the child during the first six months of life. J Bone Joint Surg Am 1976; 58:1000–1004.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
