Journal article
An Inverted Acetabular Labrum Is Predictive of Pavlik Harness Treatment Failure in Children With Developmental Hip Dysplasia
Journal of pediatric orthopaedics, Vol.41(8), pp.479-482
09/01/2021
DOI: 10.1097/BPO.0000000000001916
PMID: 34267151
Abstract
Introduction: The failure rate of Pavlik harness treatment for developmental dysplasia of the hip (DDH) has been reported as high as 55%. The purpose of this study is to investigate the effect of an inverted acetabular labrum on outcomes of Pavlik harness treatment for DDH. Methods: A retrospective review was conducted on DDH patients at a tertiary care pediatric hospital from 2004 to 2016. DDH patients that underwent index treatment with Pavlik harness and had minimum 12 months follow-up were included. Medical charts were reviewed for demographics, treatment, and outcomes. Outcomes were compared between patients with an inverted labrum versus those without an inverted labrum. Results: A total of 156 patients with 229 dysplastic hips were included. The mean age at initiation of Pavlik harness treatment was 1.9 +/- 1.4 months and mean follow-up was 37.7 +/- 23.0 months. Bilateral DDH was diagnosed in 46% (73/156) of patients. In all, 37% (75/229) of hips failed Pavlik harness index treatment. Second-line treatment was rigid hip abduction bracing in 91% (68/75) of hips, closed reduction in 5% (4/75) of hips, and open reduction in 4% (3/75) of hips. An inverted labrum was present in 10% (22/229) of all hips. The incidence of Pavlik harness treatment failure was 91% (20/22) in the inverted labrum group compared with 27% (55/207) in the control group (P<0.001). Closed or open reduction was required in 86% (15/22) of the inverted labrum group compared with 3% (7/207) of hips in the control group (P<0.001). The incidence of avascular necrosis was 18% (4/22) in hips with an inverted labrum compared with 0.4% (1/207) in the control group (P<0.001). Conclusions: In children with DDH undergoing index treatment in a Pavlik harness, the presence of an inverted acetabular labrum is strongly predictive of treatment failure. Dysplastic hips with an inverted labrum also have a significantly higher risk of requiring closed or open reduction and developing avascular necrosis compared with those without an inverted labrum.
Details
- Title: Subtitle
- An Inverted Acetabular Labrum Is Predictive of Pavlik Harness Treatment Failure in Children With Developmental Hip Dysplasia
- Creators
- Adrian J. Lin - Children's Orthopaedic Center Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA University of Florida College of Medicine at Jacksonville, Jacksonville, FL.Ali A. Siddiqui - Children's Hospital of Los AngelesLillian M. Lai - Florida CollegeRachel Y. Goldstein - Orthopaedic Center
- Resource Type
- Journal article
- Publication Details
- Journal of pediatric orthopaedics, Vol.41(8), pp.479-482
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/BPO.0000000000001916
- PMID
- 34267151
- ISSN
- 0271-6798
- eISSN
- 1539-2570
- Number of pages
- 4
- Language
- English
- Date published
- 09/01/2021
- Academic Unit
- Radiology
- Record Identifier
- 9984318794302771
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