Key result
Achieving imaging recovery criteria before stopping Pavlik Harness treatment for developmental hip dysplasia was associated with a lower rate of persistent acetabular dysplasia (7.3% vs 41.7%; P=0.007).
Why the study?
Some patients with developmental dysplasia of the hip successfully treated with a Pavlik harness before 6 months of age still experience persistent acetabular dysplasia, but the incidence and risk factors were unclear.
What are the incidence and risk factors for persistent acetabular dysplasia in patients with developmental dysplasia of the hip treated by Pavlik Harness?
Cohort (n=89)
What are the incidence and risk factors for persistent acetabular dysplasia in patients with developmental dysplasia of the hip treated by Pavlik Harness?
Absolute Event Rate: 7.3% vs 41.7%
p-value: p=0.007
Older age and higher Graf classification are risk factors for persistent acetabular dysplasia in DDH patients treated with a Pavlik Harness.
Risk factors for persistent acetabular dysplasia after Pavlik harness are hypothesis-generating; prospective studies needed before changing DDH surveillance.
Some patients with developmental dysplasia of the hip (DDH) before 6 months of age successfully treated by Pavlik Harness (PH) still had persistent acetabular dysplasia (PAD). This study aimed to investigate the incidence and risk factors for PAD in patients with DDH treated by PH. We retrospectively reviewed the data of 89 patients (109 hips; mean age, 3.2 ± 1.5 months) with DDH treated by PH. Prior to treatment, all patients underwent ultrasound examination and classified according to Graf's method. PH was terminated once the hip achieved imaging recovery criteria. At final follow-up, the acetabular index (AI), center-edge angle (CEA) of Wiberg were measured on radiograph. Overall, 67/109 hips (61.5%) had successful PH treatment. Among these 67 hips, 58 hips (86.6%) achieved satisfactory outcome, nine (13.4%) had PAD. Age of the patients with PAD (4.3 ± 1 months) was significantly higher than those without PAD (2.8 ± 1.5 months) ( P = 0.001). Hips with PAD had higher mean Graf grade than those with satisfactory outcome ( P = 0.014). Logistic regression-confirmed age and Graf classification were risk factors for PAD. Overall, 55/67 (82.1%) met imaging recovery criteria to stop PH treatment, whereas 12/67 hips (17.9%) did not. The rate of PAD at final follow-up in patients achieving recovery criteria (4/55; 7.3%) was significantly lower than those not achieving it (41.7%) ( P = 0.007). In conclusion, age and Graf classification are risk factors for PAD. If hips are not normal at the end of PH treatment, the risk of PAD increases further.
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Li et al. (2022) conducted a cohort in Developmental dysplasia of the hip (DDH) (n=89). Achieving imaging recovery criteria vs. Not achieving imaging recovery criteria was evaluated on Persistent acetabular dysplasia (PAD) (p=0.007). Achieving imaging recovery criteria before stopping Pavlik Harness treatment for developmental hip dysplasia was associated with a lower rate of persistent acetabular dysplasia (7.3% vs 41.7%; P=0.007).
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