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Difficult-to-treat Ortolani-positive hip: improved success with new treatment protocol
Vineeta T Swaroop1, Scott J Mubarak
1Rehabilitation Institute of Chicago, Chicago, IL, USA.
Insights
Improved treatment for developmental dysplasia of the hip (DDH) in infants, using serial ultrasound and abduction orthoses, increased success rates to 93%. This enhanced protocol reduced the need for open reduction surgery in Ortolani-positive hips.
Area of Science:
- Orthopaedic surgery
- Pediatric orthopaedics
- Developmental dysplasia of the hip
Background:
- Review of treatment outcomes for dislocated but reducible (Ortolani-positive) hips.
- Developmental dysplasia of the hip (DDH) is a common paediatric condition requiring timely intervention.
Purpose of the Study:
- To compare the outcomes of two treatment protocols for Ortolani-positive hips in infants under 6 months.
- To evaluate the efficacy of adding serial ultrasound and abduction orthoses to Pavlik harness treatment.
Main Methods:
- Comparative retrospective review of infants with Ortolani-positive hips treated between 1984-1994 (Group 1) and 1997-2007 (Group 2).
- Group 1 received Pavlik harness and parental education. Group 2 received the same plus serial ultrasound and abduction orthoses for unstable hips.
- Exclusion criteria included insufficient follow-up, neuromuscular disease, or irreducible dislocations.
Main Results:
- Group 1 (n=52) had an 85% success rate with Pavlik harness alone; 8 hips required further treatment.
- Group 2 (n=44) achieved a 93% success rate with the enhanced protocol; 3 hips required further treatment.
- No cases of avascular necrosis were reported in either group.
Conclusions:
- The enhanced protocol (serial ultrasound and abduction orthoses) significantly improved success rates for Ortolani-positive hips (93% vs. 85%).
- This updated treatment module reduced the rate of open reduction from 10% to 5%.
- Current success rates exceed previously reported studies, highlighting the protocol's effectiveness.
Background:
The aim of this paper was to review the outcomes of treatment of dislocated but reducible (Ortolani-positive) hips.
Methods:
A comparative retrospective review was conducted of all patients aged younger than 6 months who presented for treatment of developmental dysplasia of the hip for two 10-year periods. The inclusion criteria consisted of a clinical evaluation documenting Ortolani-positive examination, no previous treatment, and an initial treatment with Pavlik harness only. Patients with insufficient follow-up, neuromuscular disease, provocative dislocatable hips, or dislocated but not reducible hips were excluded. In group 1 (1984-1994), treatment involved initiation of Pavlik harness and parental education at the time of initial diagnosis. Group 2 (1997-2007) was treated the same as group 1 with the addition of serial orthopaedic office-based ultrasound examinations and use of a hip abduction orthosis in hips remaining unstable after 3 weeks in the Pavlik harness. Records were assessed for successful achievement and maintenance of hip reduction, need for and type of further treatment, and development of avascular necrosis.
Results:
In group 1, the mean time of follow-up was 28 months. Forty-four (85%) of 52 hips were treated successfully. Eight patients required further operative treatment. In group 2, the mean follow-up to the final evaluation was 34 months. Forty-one (93%) of 44 hips were treated successfully. Three hips required further treatment. There were no documented cases of avascular necrosis in patients treated for orthoses only in either group.
Conclusions:
In 1994, we presented a series of 52 Ortolani-positive hips (group 1) with a success rate of reduction of 85%. Now, our protocol for treating Ortolani-positive hips has evolved to include serial orthopaedic office-based ultrasound in all patients and use of a hip abduction orthosis in hips remaining unstable after 3 weeks in a Pavlik harness. Three previous studies at major centers reported successful reduction in only 63% to 71%. In group 2, our current success rate of 93% exceeds that previously reported by us and is significantly greater than these 3 previous studies (all P < 0.006). Furthermore, our current treatment module has decreased our rate of open reduction from 10% in group 1 to 5% in group 2. LEVEL OF RELEVANCE: Therapeutic study, level 3.
