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Follow-up after successful treatment for developmental dysplasia of the hip using a Pavlik harness : is two years
Jessica P J Larwood1, Opeyemi Idowu1, Kirsten G B Elliott1
1Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Insights
Children successfully treated for developmental dysplasia of the hip (DDH) with a Pavlik harness can be discharged at age two if findings are normal. This study confirms no relapses occurred by age five in these cases.
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip (DDH)
- Pavlik Harness Treatment
Background:
- The optimal follow-up duration for children successfully treated for DDH using a Pavlik harness is not well-established.
- Uncertainty exists regarding when to safely discontinue routine clinical and radiological monitoring.
Purpose of the Study:
- To determine if children with DDH, treated successfully with a Pavlik harness and showing normal clinical/radiological findings at age two, can be discharged from routine follow-up.
- To assess the long-term outcomes up to age five in this patient cohort.
Main Methods:
- Prospective data collection on 101 children (170 hips) treated with a Pavlik harness between 2015-2016.
- Radiographs (hip AP) were taken at ages one, two, and five years.
- Normal hip radiography defined by acetabular index, symmetrical ossific nuclei, IHDI grade 1, and CEA > 20°.
Main Results:
- 92% (157/170 hips) demonstrated normal radiological findings at age two.
- All hips that were normal at age two remained normal at age five.
- Children with normal findings at age two experienced no further interventions or relapses by age five.
Conclusions:
- Successful Pavlik harness treatment for DDH allows for safe discharge from routine follow-up at age two years.
- This recommendation applies to children with normal clinical and radiological assessments at the two-year mark.
- Discharging patients earlier can optimize healthcare resource allocation.
Aims:
The length of time for which children, who are treated successfully for developmental dysplasia of the hip (DDH) in a Pavlik harness should be followed up, remains uncertain. The aim of this study was to examine whether children who are treated in this way, who have normal clinical and radiological findings at the age of two years, can be safely discharged from routine follow-up.
Methods:
Data were collected prospectively on all 101 children (170 hips) who were treated in a Pavlik harness in our children's hospital between January 2015 and June 2016, with follow-up to the age of five years. Demographic, clinical, and radiological parameters were recorded. Routine anteroposterior radiographs of both hips were taken at the age of one, two and five years. A normal radiograph of the hip was defined as one with an acetabular index (AI) within the normal range when adjusted for age, symmetrical and adequately sized ossific nuclei, an International Hip Dysplasia Institute grade of 1 and a centre-edge angle (CEA) of > 20°.
Results:
Of the 101 children (170 hips) who were successfully treated in this way and had radiographs available for analysis from the three timepoints, 157 hips (92%) were normal radiologically at the age of two years and all were normal radiologically at the age of five years. Every child who had normal radiographs at the age of two years had normal clinical and radiological findings at five years, with none having any intervention.
Conclusion:
These findings support the suggestion that, following successful treatment with a Pavlik harness, children with DDH can be safely discharged from the clinic, assuming that they are clinically and radiologically normal, at the age of two years instead of five.
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