Sponsored Research and Clinical Trials

PLEASE NOTE, IHDI -funded research grants do not provide for institutional overheads and/or indirect costs of research.

IHDI Research

IHDI Research

Featured Research

IHDI Classification of Hip Dysplasia

Reliability of a New Radiographic Classification for Developmental Dysplasia of the Hip. Narayanan U, Mulpuri K, Sankar WN, Clarke NM, Hosalkar H, Price CT; International Hip Dysplasia Institute. J Pediatr Orthop. 2015;35(5):478-84

A new classification of hip dysplasia was developed by the International Hip Dysplasia Institute (IHDI). This Classification has been validated and published in the Journal of Pediatric Orthopedics. The value of any classification system is so that doctors can compare similar cases and identify treatments for mild cases that may be different from treatments for severe cases. Classification of types of hip dysplasia also allows comparisons between medical centers because some centers may have more of the mild cases while other centers may have more of the severe cases. Comparing similar cases can identify those centers with the best results so we can learn from that experience.

The IHDI Classification grades severity from Grade 1 as the mildest type to Grade 4 as the most severe type of hip dislocation. There are other ways to classify hip dysplasia, but the IHDI Classification has been proven more reliable and more accurate than the older classification methods. Three independent studies outside of IHDI have evaluated the IHDI Classification for accuracy and validity. Each has proven that the IHDI Classification does what it’s supposed to do.

In studies from other centers, the IHDI Classification has improved early identification of patients that benefit from different treatments. An example is that IHDI Grade III hips can be treated with a Pavlik harness until the age of 12 months. Previously, the Pavlik harness was recommended only until age 6 months because of high failure rates after six months. Accurate separation of Grade III dislocations from Grade IV dislocations has expanded the usefulness of the Pavlik harness for some infants. The IHDI Classification has also helped identify patients who will need open reduction instead of attempting less successful procedures. The IHDI Classification is also useful with pre-operative planning to determine which patients are likely to need femoral and/or pelvic osteotomy at the time of open reduction.

Biomechanical Engineering

An ongoing collaboration between the University of Central Florida’s College of Engineering, Embry Riddle Aeronautical College, and IHDI continues to be productive. Initially, a computer simulation model of an infant with hip dysplasia was developed so that improvements in harness and brace treatment could be studied in a theoretical manner before being tested in infants. The ability to produce reliable computer models has advanced dramatically in the past ten years. The initial efforts were supported by generous donations to the IHDI. Those preliminary results led to a $350,000 grant award from The National Science Foundation to improve the model and continue investigation of non-surgical methods of treating hip dysplasia. This has resulted in several new findings that have been taken from the computer models and are now being applied to patient care. This work continues although additional funding is needed to continue this important work.

    1. Mechanics of hip dysplasia reductions in infants using the Pavlik harness: A physics-based computational model Ardila OJ, Divo EA, Moslehy FA, Rab GT, Kassab AJ, Price CT.. J Biomech 46(9):1501-7, 2013.
    2. A patient-specific model of the biomechanics of hip reduction for neonatal Developmental Dysplasia of the Hip: Investigation of strategies for low to severe grades of Developmental Dysplasia of the Hip. Huayamave V, Rose C, Serra S, Jones B, Divo E, Moslehy F, Kassab AJ, Price CT. J Biomech. 2015 Jul 16;48(10):2026-33.
  • Developmental dysplasia of the hip: A computational biomechanical model of the path of least energy for closed reduction.
    1. Zwawi MA, Moslehy FA, Rose C, Huayamave V, Kassab AJ, Divo E, Jones BJ, Price CT. J Orthop Res. 2017 Aug;35(8):1799-1805.
  • Biomechanical evaluation of femoral anteversion in developmental dysplasia of the hip and potential implications for closed reduction. 
  1. Huayamave V, Lozinski B, Rose C, Ali H, Kassab A, Divo E, Moslehy F, Price C.Clin Biomech (Bristol, Avon). 2020 Feb;72:179-185.

Landmark Study of Pavlik Harness Management

Evaluation of Brace Treatment for Infant Hip Dislocation in a Prospective Cohort: Defining the Success Rate and Variables Associated with Failure.

Upasani VV, Bomar JD, Matheney TH, Sankar WN, Mulpuri K, Price CT, Moseley CF, Kelley SP, Narayanan U, Clarke NM, Wedge JH, Castañeda P, Kasser JR, Foster BK, Herrera-Soto JA, Cundy PJ, Williams N, Mubarak SJ. J Bone Joint Surg Am. 2016 Jul 20;98(14):1215-21.

With your financial help, the International Hip Dysplasia Institute conducted a detailed comparison of treatments and results at eight major pediatric medical centers around the world. This was only possible because of the internet and because of computerized data collection that was in early stages of development when this project was initiated. International cooperation necessitated review and approval by ethical oversight committees five different countries. After obtaining appropriate consents for participation, all patients were carefully tracked and analyzed for differences in grade, treatment, and results. The IHDI registered the largest number of newborn hip dislocations that have ever been identified with imaging prior to treatment. Numerous observations were made from these results that will continue to improve patient care and identify areas that still need improvement. This study was intended to end after completion, but the value was recognized by IHDI members, and especially by Kishore Mulpuri, MD at the University of Vancouver. With initial funding from IHDI, Dr. Mulpuri was able to create the International Hip Dysplasia Registry (IHDR) that has continued to follow patients from the IHDI study. The International Hip Dysplasia Registry has since expanded to include many more patients with hip dysplasia from centers around the World. https://www.bcchr.ca/IHDR The IHDI is grateful for this continued research by the IHDR. We are supportive of the important research being done by IHDR for orthopedic management of hip dysplasia.

Pavlik Harness Consensus

This project was conceived by IHDI and conducted under the direction of Simon Kelley, MD, PhD at the University of Toronto, Hospital for Sick Children. The first phase of this project achieved consensus for the standardized application of the Pavlik Harness as practiced by a group of IHDI experts. This was validated and a test of skill was developed to measure the student’s capability of applying the Pavlik harness properly. Dr. Kelley’s video is available elsewhere on the IHDI website. The second phase achieved consensus on the management of Developmental Hip Dysplasia using the Pavlik Harness. There are often differences of opinions about how long to use the harness if it’s failing or if it’s successful, when to stop treatment, what to do at time of stopping and other treatment decisions. The IHDI Consensus provides an acceptable standard that is used by the IHDI group for making treatment decisions when using Pavlik harness to treat infants. The Delphi Method was used in these studies as a scientific method for consensus development and we are grateful to Dr. Kelley and his colleagues for providing some consistency to Pavlik harness application and use.

Expert-Based Consensus on the Principles of Pavlik Harness Management of Developmental Dysplasia of the Hip. Kelley SP, Feeney MM, Maddock CL, Murnaghan ML, Bradley CS. JB JS Open Access. 2019 Oct 7;4(4):e0054.

 

Skill Acquisition and Retention Following Simulation-Based Training in Pavlik Harness Application. Moktar J, Bradley CS, Maxwell A, Wedge JH, Kelley SP, Murnaghan ML. J Bone Joint Surg Am. 2016;98(10):866-70.

 

Education of parents in Pavlik harness application for developmental dysplasia of the hip using a validated simulated learning module. Gargan KE, Bradley CS, Maxwell A, Moktar J, Wedge JH, Murnaghan ML, Kelley SP. J Child Orthop. 2016 Aug;10(4):289-93

 

A Reliable and Valid Objective Structured Assessment of Technical Skill for the Application of a Pavlik Harness Based on International Expert Consensus.

Bradley CS, Moktar J, Maxwell A, Wedge JH, Murnaghan ML, Kelley SP. J Pediatr Orthop. 2016 Oct-Nov;36(7):768-72

 

IHDI Scientific Publications

  • Reliability of a New Radiographic Classification for Developmental Dysplasia of the Hip. Narayanan U, Mulpuri K, Sankar WN, Clarke NM, Hosalkar H, Price CT; International Hip Dysplasia Institute. J Pediatr Orthop. 2015;35(5):478-84Sankar WN, Gornitzky AL, Clarke NMP, Herrera-Soto JA, Kelley SP, Matheney T, Mulpuri K, Schaeffer EK, Upasani VV, Williams N, Price CT; International Hip Dysplasia Institute. J Pediatr Orthop. 2019 Mar;39(3):111-118.
    1. Closed Reduction for Developmental Dysplasia of the Hip: Early-term Results from a Prospective, Multicenter Cohort.
    2. Should I Plan to Open? Predicting the Need for Open Reduction in the Treatment of Developmental Dysplasia of the Hip. Talathi NS, Trionfo A, Patel NM, Upasani VV, Matheney T, Mulpuri K, Sankar WN. J Pediatr Orthop. 2020 May/Jun;40(5):e329-e334.
    3. Expert-Based Consensus on the Principles of Pavlik Harness Management of Developmental Dysplasia of the Hip. Kelley SP, Feeney MM, Maddock CL, Murnaghan ML, Bradley CS. JB JS Open Access. 2019 Oct 7;4(4):e0054.
    4. Management of Irreducible Hip Dislocations in Infants with Developmental Dysplasia of the Hip Diagnosed Below 6 Months of Age. Aarvold A, Schaeffer EK, Kelley S, Clarke NMP, Herrera-Soto JA, Price CT, Mulpuri K; IHDI Study Group. J Pediatr Orthop. 2019 Jan;39(1):e39-e43.
    5. What Risk Factors and Characteristics Are Associated with Late-presenting Dislocations of the Hip in Infants? Mulpuri K, Schaeffer EK, Andrade J, Sankar WN, Williams N, Matheney TH, Mubarak SJ, Cundy PJ, Price CT; IHDI Study Group. Clin Orthop Relat Res. 2016 May;474(5):1131-7.
    6. A patient-specific model of the biomechanics of hip reduction for neonatal Developmental Dysplasia of the Hip: Investigation of strategies for low to severe grades of Developmental Dysplasia of the Hip. Huayamave V, Rose C, Serra S, Jones B, Divo E, Moslehy F, Kassab AJ, Price CT. J Biomech. 2015 Jul 16;48(10):2026-33.
    7. What Is the Impact of Center Variability in a Multicenter International Prospective Observational Study on Developmental Dysplasia of the Hip? Mulpuri K, Schaeffer EK, Kelley SP, Castañeda P, Clarke NM, Herrera-Soto JA, Upasani V, Narayanan UG, Price CT; IHDI Study Group. Clin Orthop Relat Res. 2016 May;474(5):1138-45.
    8. Mechanics of hip dysplasia reductions in infants using the Pavlik harness: A physics-based computational model Ardila OJ, Divo EA, Moslehy FA, Rab GT, Kassab AJ, Price CT.. J Biomech 46(9):1501-7, 2013.
  • Ultrasound Characteristics of Clinically Dislocated but Reducible Hips With DDH. Striano B, Schaeffer EK, Matheney TH, Upasani VV, Price CT, Mulpuri K, Sankar WN; International Hip Dysplasia Institute. J Pediatr Orthop. 2019 Oct;39(9):453-457.
  • Evaluation of Brace Treatment for Infant Hip Dislocation in a Prospective Cohort: Defining the Success Rate and Variables Associated with Failure. Upasani VV, Bomar JD, Matheney TH, Sankar WN, Mulpuri K, Price CT, Moseley CF, Kelley SP, Narayanan U, Clarke NM, Wedge JH, Castañeda P, Kasser JR, Foster BK, Herrera-Soto JA, Cundy PJ, Williams N, Mubarak SJ. J Bone Joint Surg Am. 2016 Jul 20;98(14):1215-21.
  • Pavlik Harness Disease Revisited: Does Prolonged Treatment of a Dislocated Hip in a Harness Adversely Affect the α Angle?
    1. Gornitzky AL, Schaeffer EK, Price CT, Sankar WN; International Hip Dysplasia Institute. J Pediatr Orthop. 2018 Jul;38(6):297-304.
  • Incidence of acetabular dysplasia in breech infants following initially normal ultrasound: the effect of variable diagnostic criteria.
    1. Brusalis CM, Price CT, Sankar WN. J Child Orthop. 2017 Aug 1;11(4):272-276.
  • Developmental dysplasia of the hip: A computational biomechanical model of the path of least energy for closed reduction.
    1. Zwawi MA, Moslehy FA, Rose C, Huayamave V, Kassab AJ, Divo E, Jones BJ, Price CT. J Orthop Res. 2017 Aug;35(8):1799-1805.
  • Selective ultrasound screening is inadequate to identify patients who present with symptomatic adult acetabular dysplasia.
    1. Sink EL, Ricciardi BF, Torre KD, Price CT. J Child Orthop. 2014 Dec;8(6):451-5
    2. Prevention of hip dysplasia in children and adults. Price CT, Ramo BA. . Orthop Clin North Am. 2012 Jul;43(3):269-79.
    3. Strategies to improve nonoperative childhood management. Clarke NM, Castaneda P.  Orthop Clin North Am. 2012 Jul;43(3):281-9.
    4.  Strategies to improve outcomes from operative childhood management of DDH. Wedge JH, Kelley SP.  Orthop Clin North Am. 2012 Jul;43(3):291-9.
    5. Swaddling and Hip Dysplasia: New Observations: Commentary on an article by Enbo Wang, MD, PhD, et al.: “Does Swaddling Influence Developmental Dysplasia of the Hip? An Experimental Study of the Traditional Straight-Leg Swaddling Model In Neonatal Rats.” Price CT. J Bone Joint Surg. Am.  Jun 2012; 94 (12); e92 1-2. doi: 10.2106 /JBJS.L.00297
    6. Is swaddling damaging our babies’ hips? [Letter to the Editor] Williams N, Foster BK, Cundy PJ.  MJA Sep 2012: 197 (5).
  • Skill Acquisition and Retention Following Simulation-Based Training in Pavlik Harness Application. Moktar J, Bradley CS, Maxwell A, Wedge JH, Kelley SP, Murnaghan ML. J Bone Joint Surg Am. 2016;98(10):866-70.
  1. Education of parents in Pavlik harness application for developmental dysplasia of the hip using a validated simulated learning module.
  2. Gargan KE, Bradley CS, Maxwell A, Moktar J, Wedge JH, Murnaghan ML, Kelley SP. J Child Orthop. 2016;10(4):289-93
  3. A Reliable and Valid Objective Structured Assessment of Technical Skill for the Application of a Pavlik Harness Based on International Expert Consensus.
  4. Bradley CS, Moktar J, Maxwell A, Wedge JH, Murnaghan ML, Kelley SP. J Pediatr Orthop. 2016 Oct-Nov;36(7):768-72
  5. Developmental dysplasia of the hip: addressing evidence gaps with a multicentre prospective international study. Schaeffer EK, Study Group I, Mulpuri K. Med J Aust. 2018 May 7;208(8):359-364.

Partial list of additional publications by IHDI members (many because of IHDI discussions)

  • Late diagnosis of congenital dislocation of the hip and presence of a screening program: South Australian population-based study. Chan A, Cundy PJ, Foster BK, Keane RJ, Byron-Scott R. (1999) Lancet 354: 1514-1517.
  • Late diagnosis of developmental dysplasia of the hip: an analysis of risk factors. Azzopardi T, Van Essen P, Cundy PJ, Tucker G, Chan A (2011).  J Pediatr Orthop B 20(1):1-7.
  • The effect of femoral shortening in the treatment of developmental dysplasia of the hip after walking age. Castañeda P, Moscona L, Masrouha K.Castañeda P, et al. J Child Orthop. 2019 Aug 1;13(4):371-376.
  • Incomplete periacetabular acetabuloplasty. Carsi B, Al-Hallao S, Wahed K, Page J, Clarke NM.Carsi B, et al. Acta Orthop. 2014 Feb;85(1):66-70.
  • The incidence of avascular necrosis and the radiographic outcome following medial open reduction in children with developmental dysplasia of the hip: a systematic review. Gardner RO, Bradley CS, Howard A, Narayanan UG, Wedge JH, Kelley SP. Bone Joint J. 2014 Feb;96-B(2):279-86.
  • Long-term outcome following medial open reduction in developmental dysplasia of the hip: a retrospective cohort study.

Gardner RO, Bradley CS, Sharma OP, Feng L, Shin ME, Kelley SP, Wedge JH. J Child Orthop. 2016 Jun;10(3):179-84.

  • Avascular necrosis following closed reduction for treatment of developmental dysplasia of the hip: a systematic review. Bradley CS, Perry DC, Wedge JH, Murnaghan ML, Kelley SP. J Child Orthop. 2016 Dec;10(6):627-632.
  • Hip Vascularity: A Review of the Anatomy and Clinical Implications. Seeley MA, Georgiadis AG, Sankar WN.. J Am Acad Orthop Surg. 2016 Aug;24(8):515-26.
  • Imaging of developmental dysplasia of the hip: ultrasound, radiography and magnetic resonance imaging. Barrera CA, Cohen SA, Sankar WN, Ho-Fung VM, Sze RW, Nguyen JC. Pediatr Radiol. 2019 Nov;49(12):1652-1668
  • Operative Reduction for Developmental Dysplasia of the Hip: Epidemiology Over 16 Years. Nelson SE, DeFrancesco CJ, Sankar WN. J Pediatr Orthop. 2019 Apr;39(4):e272-e277.
  • Docking of the Femoral Head Following Closed Reduction for DDH: Does it Really Occur? Talathi NS, Chauvin NA, Sankar WN. J Pediatr Orthop. 2018 Sep;38(8):e440-e445.
  • Safe Transportation in-Spica Following Surgical Treatment of Infantile DDH: Solutions and Threats. Adams AJ, Johnson MA, Ryan KA, Farrell SB, Morro M, Sankar WN.. J Pediatr Orthop. 2019 Aug;39(7):e488-e493.
  • Coronal Flexion Versus Coronal Neutral Sonographic Views in Infantile DDH: An Important Source of Variability. Meza BC, Nguyen JC, Jaremko JL, Sankar WN. J Pediatr Orthop. 2019 Jul 12.
  • Ilfeld abduction orthosis is an effective second-line treatment after failure of Pavlik harness for infants with developmental dysplasia of the hip. Sankar WN, Nduaguba A, Flynn JM. J Bone Joint Surg Am. 2015 Feb 18;97(4):292-7.
  • Radiographic Follow-up of DDH in Infants: Are X-rays Necessary After a Normalized Ultrasound? Sarkissian EJ, Sankar WN, Zhu X, Wu CH, Flynn JM. J Pediatr Orthop. 2015 Sep;35(6):551-5.
  • Is there a predilection for breech infants to demonstrate spontaneous stabilization of DDH instability? Sarkissian EJ, Sankar WN, Baldwin K, Flynn JM. J Pediatr Orthop. 2014 Jul-Aug;34(5):509-13
  • Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age. Mulpuri K, Song KM, Goldberg MJ, Sevarino J Am Acad Orthop Surg. 2015 Mar;23(3):202-5.
  • Automatic Evaluation of Scan Adequacy and Dysplasia Metrics in 2-D Ultrasound Images of the Neonatal Hip. Quader N, Hodgson AJ, Mulpuri K, Schaeffer E, Abugharbieh R. Ultrasound Med Biol. 2017 Jun;43(6):1252-1262.
  • AAOS Clinical Practice Guideline: Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age. Mulpuri K, Song KM. J Am Acad Orthop Surg. 2015 Mar;23(3):206-7.
  • Evidence-based management of developmental dysplasia of the hip.  Cooper AP, Doddabasappa SN, Mulpuri K. Orthop Clin North Am. 2014 Jul;45(3):341-54.
  • AAOS Appropriate Use Criteria: The Management of Developmental Dysplasia of the Hip in Infants up to 6 Months of Age: Intended for Use by General Pediatricians and Referring Physicians. Schaeffer E, Lubicky J, Mulpuri K. J Am Acad Orthop Surg. 2019 Apr 15;27(8):e364-e368.
  • The American Academy of Orthopaedic Surgeons Evidence-Based Guideline on Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age. Mulpuri K, Song KM, Gross RH, Tebor GB, Otsuka NY, Lubicky JP, Szalay EA, Harcke HT, Zehr B, Spooner A, Campos-Outcalt D, Henningsen C, Jevsevar DS, Goldberg M, Brox WT, Shea K, Bozic KJ, Shaffer W, Cummins D, Murray JN, Mohiuddin M, Shores P, Woznica A, Martinez Y, Sevarino K. J Bone Joint Surg Am. 2015 Oct 21;97(20):1717-8.
  • Developmental Dysplasia of the Hip: An Examination of Care Practices of Pediatric Orthopaedic Surgeons in North America. Taylor IK, Burlile JF, Schaeffer EK, Geng X, Habib E, Mulpuri K, Shea KG. J Pediatr Orthop. 2020 Apr;40(4):e248-e255.
  • AAOS Appropriate Use Criteria: The Management of Developmental Dysplasia of the Hip in Infants up to Six Months of Age: Intended for Use by Orthopaedic Specialists. Schaeffer E, Lubicky J, Mulpuri J Am Acad Orthop Surg. 2019 Apr 15;27(8):e369-e372.
  • Should paediatricians initiate orthopaedic hip dysplasia referrals for infants with isolated asymmetric skin folds? Louer CR, Bomar JD, Pring ME, Mubarak SJ, Upasani VV, Wenger DR. J Child Orthop. 2019 Dec 1;13(6):593-599.
  • Reliability of plain radiographic parameters for developmental dysplasia of the hip in children. Upasani VV, Bomar JD, Parikh G, Hosalkar H. J Child Orthop. 2012 Jul;6(3):173-6.
  • Ultrasonography in the Diagnosis and Management of Developmental Dysplasia of the Hip. Edmonds EW, Hughes JL, Bomar JD, Brooks JT, Upasani VV. JBJS Rev. 2019 Dec;7(12):e5.
  • Positioning and baby devices impact infant spinal muscle activity. Siddicky SF, Bumpass DB, Krishnan A, Tackett SA, McCarthy RE, Mannen EM.J Biomech. 2020 May 7;104:109741.
  • Infant carrying method impacts caregiver posture and loading during gait and item retrieval. Havens KL, Severin AC, Bumpass DB, Mannen EM.Gait Posture. 2020 May 15;80:117-123

Please contact us if you would like more information about any of the above studies, or if you can make a donation for these and future research projects for hip dysplasia.

 

 

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