Abduction Orthosis in Treatment of Primary Acetabular Dysplasia: Results of Three Years Follow-up

Yıl 2021, Cilt: 2 Sayı: 3, 182 - 188, 22.09.2021

Sinan Yüksel Serhan Ünlü Onder Ersan Faruk Catma Yenel Gurkan Bilgetekin Kürşat Reşat Demir

Öz

Background: Acetabular dysplasia (AD) may appear after six-months-old despite normal previous physical and ultrasonographic examination, and management remains unclear. The purpose of the current study was to evaluate the success of abduction orthosis in the treatment of primary AD patients.

Methods: Patients presented with AD between 2010-2017 were retrospectively reviewed. The study included AD patients who had stable hip joints on previous physical examination and Graf type1 on ultrasonography when younger than six months. AD was diagnosed according to the age-related acetabular index (AI) values. Abduction orthoses were applied full-time for five months plus part-time for three months. AI was re-measured at the sixth month, at the end of the first and third year. AI change was compared between dysplastic and nondysplastic hips.

Results: It was evaluated 60 hips of 39 patients with AD treated with abduction orthosis at the median age of 6 months. The mean AI was 31.4 (range: 29-35)°±2.1° in dysplastic hips. AI decreased to 26.5°±2.2°, 24.5°±2°, 21°±2.1° at sixth months, first and third years after treatment; respectively. The mean AI of non-dysplastic hips was 25.3°(range: 22-28)±2.1°; and decreased to 22.6°±2.4°, 21.1°±2°, 17.9°±1.8° at sixth months, first and third years follow-ups, respectively. At the end of the first six months, dysplastic hips had significantly better improvement in AI (4.9±2.1°) compared to non-dysplastic hips (2.7°±0.8°) (p<0.001). There was no significant difference in AI improvement after six months.

Conclusion: Primary acetabular dysplasia should not be ignored despite normal previous physical and ultrasonographic examination. Abduction orthosis may be used in the treatment of children with primary AD older than six months.

Anahtar Kelimeler

Hip Dysplasia, Abduction Brace, Acetabular Index.

Kaynakça

• 1. Vitale MG, Skaggs DL. Developmental dysplasia of the hip from six months to four years of age. J Am Acad Orthop Surg. 2001;9(6):401–11.
• 2. Filipe G, Carlioz H. Use of the Pavlik harness in treating congenital dislocation of the hip. J Pediatr Orthop. 1982;2(4):357–62.
• 3. Pavlik A. The functional method of treatment using a harness with stirrups as the primary method of conservative therapy for infants with congenital dislocation of the hip. 1957. Clin Orthop Relat Res. 1992;89(281):4–10.
• 4. Walton MJ, Isaacson Z, McMillan D, Hawkes R, Atherton WG. The success of management with the Pavlik harness for developmental dysplasia of the hip using a United Kingdom screening programme and ultrasound-guided supervision. J Bone Joint Surg Br. 2010;92(7):1013-6.
• 5. Sankar WN, Nduaguba A, Flynn JM. Ilfeld abduction orthosis is an effective second-line treatment after failure of Pavlik harness for infants with developmental dysplasia of the hip. J Bone Joint Surg Am. 2015;97(4):292-7.
• 6. Gans I, Flynn JM, Sankar WN. Abduction bracing for residual acetabular dysplasia in infantile DDH. J Pediatr Orthop. 2013;33(7):714–8.
• 7. 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(2):175–7.
• 8. Wahlen R, Zambelli PY. Treatment of the developmental dysplasia of the hip with an abduction brace in children up to 6 months old. Adv Orthop. 2015;2015.
• 9. Broughton NS, Brougham DI, Cole WG, Menelaus MB. Reliability of radiological measurements in the assessment of the child’s hip. J Bone Joint Surg Br. 1989;71(1):6-8.
• 10. Portinaro NM, Murray DW, Bhullar TP, Benson MK. Errors in measurement of acetabular index. J Pediatr Orthop. 1995;15(6):780-4.
• 11. Spatz DK, Reiger M, Klaumann M, Miller F, Stanton RP, Lipton GE. Measurement of acetabular index intraobserver and interobserver variation. J Pediatr Orthop. 1997;17(2):174-5.
• 12. Tönnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res. 1976;119:39–47.
• 13. Smith WS, Badgley CE, Orwig JB, Harper JM. Correlation of postreduction roentgenograms and thirty-one-year follow-up in congenital dislocation of the hip. J Bone Joint Surg Am. 1968;50(6):1081–98.
• 14. Segev E, Hemo Y, Wientroub S, Ovadia D, Fishkin M, Steinberg DM, et al. Intra- and interobserver reliability analysis of digital radiographic measurements for pediatric orthopedic parameters using a novel PACS integrated computer software program. J Child Orthop. 2010;4(4):331–41.
• 15. Shaw KA, Moreland CM, Olszewski D, Schrader T. Late acetabular dysplasia after successful treatment for developmental dysplasia of the hip using the Pavlik method: A systematic literature review. J Orthop. 2018;16(1):5-10.
• 16. Salter RB. Role of innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip in the older child. J Bone Joint Surg Am. 1966;48(7):1413-39.
• 17. Dornacher D, Cakir B, Reichel H, Nelitz M. Early radiological outcome of ultrasound monitoring in infants with developmental dysplasia of the hips. J Pediatr Orthop Part B. 2010;19(1):27–31.
• 18. Sarkissian EJ, Sankar WN, Zhu X, Wu CH, Flynn JM. Radiographic Follow-up of DDH in Infants: Are X-rays Necessary After a Normalized Ultrasound? J Pediatr Orthop. 2015;35(6):5515.
• 19. Ömeroğlu H, Köse N, Akceylan A. Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip. Clin Orthop Relat Res. 2016;474(5):1146-52.