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Standardized In-harness Ultrasound Protocol Improves Success Rate of Brace Treatment for Dislocated Hips
Carlos D Pargas-Colina1, Caleb M Allred2, Apeksha Gupta1
1Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital.
Insights
Standardizing ultrasound imaging for infant hip dislocations treated with a Pavlik harness significantly improves success rates. This protocol helps prevent premature treatment cessation and reduces the need for surgery.
Area of Science:
- Pediatric Orthopedics
- Medical Imaging
- Developmental Dysplasia of the Hip
Background:
- Infant hip dislocations require early detection and treatment for optimal outcomes.
- Current practices show significant institutional variability in Pavlik harness treatment success rates.
- Lack of standardized imaging guidelines for Pavlik harness treatment monitoring contributes to inconsistent outcomes.
Purpose of the Study:
- To evaluate if a standardized in-harness ultrasound imaging protocol improves treatment outcomes for infant hip dislocations managed with a Pavlik harness.
- To determine if standardization reduces variability in monitoring treatment success or failure.
Main Methods:
- Retrospective cohort study including 128 hips (97 patients) with hip dislocations and pretreatment ultrasound (US) from July 2018 to July 2022.
- Comparison of outcomes between a nonstandardized group (before July 2020) and a standardized group (after July 2020) that implemented a new institutional US protocol.
- Statistical significance determined by P <0.05.
Main Results:
- The standardized group showed a significantly higher Pavlik harness success rate (85%) compared to the nonstandardized group (60%, P = 0.0024).
- Fewer hips required surgical intervention in the standardized group (8 hips) versus the nonstandardized group (28 hips).
- No significant differences in patient demographics or baseline characteristics were observed between the groups.
Conclusions:
- Standardizing in-harness ultrasound imaging for developmental hip dislocations treated with a Pavlik harness significantly enhances treatment success.
- Proper imaging technique, including hip flexion and abduction, is crucial to avoid stress on unstable hips and prevent premature discontinuation of the harness.
Objective:
Infant hip dislocations benefit from early detection and treatment for optimal outcomes. Prior studies have identified that there remains wide variability in the success rate of bracing between institutions. Although there are standardized methods to screen infants for hip dysplasia, there are no clear guidelines regarding how to image a child being treated for a hip dislocation with a Pavlik harness. As a result, there is substantial variability in how treatment success or failure is monitored between and within institutions. The goal of our study is to determine whether a standardized in-harness imaging protocol improves outcomes and the likelihood of successful treatment for dislocated hips being treated with the Pavlik harness.
Methods:
All patients with hip dislocations and pretreatment ultrasound (US) were included from July 2018 to July 2022. A new institutional US protocol was implemented in July 2020, during which standardized in-harness imaging was obtained for patients with hip dislocations. Patients treated before the implementation of standardized in-harness imaging were categorized as nonstandardized and after implementation as a standardized group. Outcomes were compared between standardized and nonstandardized groups. P <0.05 determined the statistical significance.
Results:
One hundred twenty-eight hips met the inclusion criteria (n = 97 patients). The mean age at diagnosis was 41.6 ± 23.4 days and was predominantly female (85.6%). There was no significant difference between the patients' demographics and baseline clinical characteristics between the standardized and nonstandardized groups. Pavlik harness success rate was significantly higher in the standardized group (85% vs 60%, P = 0.0024). Twenty-eight hips in the nonstandardized group remained dislocated and were indicated for surgical treatment, whereas only 8 hips remained dislocated in the standardized group and necessitated closed or open reduction.
Conclusions:
Standardization of in-harness imaging for patients undergoing treatment for developmental hip dislocations can significantly improve the Pavlik harness success rate. These findings emphasize the importance of obtaining images with the hip in flexion and abduction to prevent inadvertent stress during US evaluation for hips that have not yet stabilized, which may lead to premature cessation of the Pavlik harness.
Level Of Evidence:
Level III.
