New Protocol for Older Infants May Avoid Cast or Surgery

The International Hip Dysplasia Institute has been looking into methods for bracing older children with dislocated hips. The goal is to decrease the need for casts or surgery between the ages of six months and 18 months. In addition, this could have great benefits for underdeveloped regions where late detection is common.
It has already been shown that some infants between six and twelve months of age can be treated successfully with the Pavlik harness. Initial reduction may take as long as six weeks, and the Pavlik harness is rarely successful for more severe dislocations after six months of age. If your child is diagnosed between six and twelve months of age, you might want to discuss this option with your doctor. When the Pavlik harness has failed before six months of age, there may be some benefit trying a different type of brace or having no treatment for a month and then trying again with the Pavlik harness instead of proceeding immediately to casts or surgery.
For more severe dislocations and dislocations in older infants, a method of harness treatment was developed in Greece and published more than ten years ago in the prestigious Journal of Bone and Joint Surgery. At that time, it seemed impossible and risky, but a few children in the USA have had this treatment with some success. A few members of the International Hip Dysplasia Institute are cautiously beginning to explore the use this method for some children who are diagnosed with a dislocated hip between the ages of six and eighteen months.
In November, 2018 a delegation of four IHDI physicians traveled to Greece to study the new method, called the Papadimitriou Method. Additional discussions have identified some key principles that may be useful. Appropriate harnesses and braces for this method are now available at some centers in the USA. The period of treatment and bed rest is about the same as with cast immobilization, but the child maintains active hip movement that may help stimulate hip development, and ease the burden of care; perhaps with fewer episodes of general anesthesia.
Standard care in the USA for children diagnosed between six and eighteen months old is casts or surgery, but these new methods are promising and could be more widely applied if successful. Contact IHDI if you have additional questions about treatment for older infants. A Power Point presentation is available online for physicians who would like to learn more about this method. Click here to view presentation.

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