Postponed Treatment Option for Older Infants

Surgery may be postponed for hip dysplasia because of limited surgical access during the COVID-19 epidemic. [] The IHDI has posted suggestions for managing patient care during this period if resources are limited in your region. However, there is another option that may be worth considering when a trip to the operating room is next step in your child’s care.

In December, 2019, IHDI reported a new protocol that may help older infants avoid casts or surgery. [] This method has the potential to treat children older than six months with a harness to gain reduction as an outpatient. The principles are very similar to the Pavlik harness except that the Pavlik harness is less successful after six months of age. The main difference between this new method and the Pavlik harness is that the hips are flexed up to a greater amount than with the Pavlik harness. This is possible because the preferred harness in this age group only supports the thigh without attaching to the lower leg or foot. This allows the knee to extend freely but holds the hips in a flexed position until the joint ligaments are stretched enough to allow the hip to go back into the socket.

Success in a high number of patients has been reported in the American Journal of Bone and Joint Surgery, a respected peer-reviewed journal, so this is not a new method. Unfortunately, the method was developed in Greece and few doctors in North America have any experience with it. Nonetheless, the first step is similar to a Pavlik harness treatment, and that is familiar to almost all pediatric orthopedic surgeons in North America. Several research studies have shown that children older than six months can wear harnesses for up to six weeks without damaging the hip socket even if the hip does not reduce. In younger infants, three weeks is enough time to see if the hip will reduce, but harness reduction may take longer after six months of age.

While waiting for the operating rooms to open up, there may be some benefit in attempting this method for six weeks to determine whether surgery can be avoided.

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