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Risk Factors for Failure of Pavlik Harness Treatment in Infants With Dislocated Hips That Are Evaluated by Dynamic
Ahmet Imerci1,2, Kenneth J Rogers1, Abhishek Bhattacharjee3
1Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
Insights
Pavlik harness treatment failed in 39% of infants with frankly dislocated hips. Key risk factors for Pavlik harness failure in developmental dysplasia of the hip include delayed treatment, fixed hip dislocations, and infants of multigravida mothers.
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
- Pediatric Musculoskeletal Conditions
Background:
- Frankly dislocated hips, a severe form of developmental dysplasia of the hip (DDH), occur in 1-3% of infants.
- These irreducible dislocations present significant treatment challenges.
- Identifying risk factors for treatment failure is crucial for optimizing outcomes.
Purpose of the Study:
- To determine risk factors for Pavlik harness failure in infants with irreducible dislocated hips.
- Utilizing univariate and multivariate analyses to identify predictors of treatment success.
Main Methods:
- Evaluation of 124 infants (170 hips) with frankly dislocated hips treated with Pavlik harness (2000-2018).
- Data collected included demographics, clinical and dynamic sonographic findings (dislocated-fixed vs. dislocated-mobile), age at treatment initiation, and duration of harness use.
- Univariate and multivariate analyses were performed to identify risk factors for treatment failure.
Main Results:
- Pavlik harness treatment was successful in 61% (104/170 hips) and failed in 39% (66/170 hips).
- Risk factors for failure identified by univariate analysis included treatment initiation after 7 weeks of age and initial hip mobility (dislocated-fixed group).
- Multivariate analysis identified infants of multigravida mothers (non-firstborn) as an additional risk factor. Treatment failure increased significantly with the number of risk factors present.
Conclusions:
- Thirty-nine percent of frankly dislocated, irreducible hips failed Pavlik harness treatment.
- Independent risk factors for Pavlik harness failure in this cohort were: treatment initiated after the seventh week of age, being an infant of a multigravida mother, and initial hip mobility (fixed-dislocated hips) as determined by dynamic sonography.
Background:
Frankly dislocated hips occur in ∼1% to 3% of infants with developmental dysplasia of the hip and are often difficult to treat. In the most severely dislocated hips, the femoral head is positioned outside the posterior/lateral rim of the acetabulum and is irreducible, that is, the femoral head will not reduce by positioning the leg. The purpose of this study was to determine risk factors, using univariate and multivariate analyses, for Pavlik harness failure in infants who initially presented with irreducible/dislocated hips (confirmed by dynamic sonography).
Methods:
Following institutional review board approval, 124 infants (170 hips) with frankly dislocated hips treated using a Pavlik harness between 2000 and 2018 were evaluated. Patients' demographic characteristics, clinical findings, dynamic sonographic findings (dislocated-fixed vs. dislocated-mobile), age at onset of Pavlik harness treatment, duration of harness usage, and follow-up treatments were recorded. Univariate analyses were used to determine risk factors for treatment failure.
Results:
In frankly dislocated hips (confirmed by dynamic sonography to be positioned outside the posterior/lateral rim of the acetabulum), Pavlik harness treatment was successful in 104 of 170 hips (61%) while it failed in 66 hips. Mean follow-up was 4.86±4.20 years. Univariate analysis determined the risk factors to be onset of treatment after the seventh week of age (P=0.049) and initial mobility (dislocated-fixed group) (P<0.001) by dynamic sonography. In addition, multivariate analysis (P=0.007) showed infants of multigravida mothers (non-firstborn) to be another risk factor for failure. Six percent of hips with no risk factors failed Pavlik harness treatment, those with 1 risk factor had 42% failure, 2 risk factors had 69% failure, and all 3 risk factors had 100% failure.
Conclusions:
In our patients with frankly dislocated irreducible hips, 39% of hip failed Pavlik harness treatment. Independent multivariate, logistic regression analysis, and multivariate analysis determining the risk factors for failure of Pavlik harness treatment were onset of treatment after the seventh week of age, infants of multigravida mothers, and initial hip mobility (fixed-dislocated hips) by dynamic sonography.
Level Of Evidence:
Level III.
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