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Treatment of Graf's ultrasound class III and IV hips using Pavlik's method
Eli Peled1, Viktor Bialik, Alexander Katzman
1Department of Orthopedic Surgery B, Rambam Health Care Campus, Haifa, Israel.
Insights
Pavlik
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
- Pediatric Imaging
Background:
- Congenital hip dislocation treatment aims to minimize osteonecrosis.
- Graf's sonographic method enables early diagnosis of developmental dysplasia of the hip (DDH).
Purpose of the Study:
- To investigate factors correlating with osteonecrosis risk in Graf Type III or IV hips.
- To evaluate the efficacy of Pavlik's method in treating DDH and preventing osteonecrosis.
Main Methods:
- Clinical and sonographic screening of 18,067 neonates for DDH over 4 years.
- Analysis of 78 neonates with Graf Type III or IV hips treated with Pavlik's method.
- Outcome assessment for osteonecrosis in treated hips.
Main Results:
- Sixteen of 65 (25%) Graf Type III hips reduced spontaneously.
- Pavlik's method achieved reduction in 46/65 (88.5%) Type III and 8/13 (61.5%) Type IV hips.
- No osteonecrosis was observed in hips treated exclusively with Pavlik's method.
Conclusions:
- Pavlik's method effectively treats developmental dysplasia of the hip, achieving reduction in most cases.
- Exclusive use of Pavlik's method for Graf Type III/IV hips significantly reduces osteonecrosis incidence.
- This method successfully meets the original goal of minimizing osteonecrosis in DDH treatment.
Unlabelled:
When Pavlik introduced his method of treating congenital dislocation of the hip, he emphasized reducing the rate of osteonecrosis. Graf's method of sonographic evaluation afforded earlier accurate diagnosis and subsequent treatment of developmental dysplasia of the hip. To ascertain whether treatment duration, gender, age at diagnosis, clinical stability, and/or treatment onset correlate with the risk of osteonecrosis in Graf Type III or IV hips, we clinically and sonographically screened 18,067 neonates (36,134 hips) for developmental dysplasia of the hip over a 4-year period; 151 had Graf Type III or IV hips, and 78 of these were treated by us and had known outcomes. Of these 78 hips, 65 (0.18%) had Graf Type III and 13 (0.036%) had Graf Type IV hips. Sixteen of the 65 Type III hips (25%) reduced spontaneously. Using Pavlik's method, reduction was achieved in 46 of 65 (88.5%) Type III hips and eight of 13 Type IV hips. None of the hips treated exclusively by Pavlik's method developed osteonecrosis. Thus, the method achieves one of Pavlik's original goals of decreasing osteonecrosis incidence to close to zero.
Level Of Evidence:
Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
