The annual meeting of the European Pediatric Orthopedic Society concluded on Saturday, April 19. There were several scientific presentations about DDH during childhood along with more research about adolescent and adult dysplasia. Some papers were particularly interesting with regards to DDH treatment. Some had good news and some had bad news for patients with hip dysplasia.
Professor Kamegaya from Japan reported that a second attempt with the Pavlik harness may be successful after the first attempt fails. After the initial failure, the child is not treated for four weeks and then the Pavlik harness is reapplied. The second attempt was successful in almost half of 40 infants given a second chance in the harness. The reasons for this success weren’t clear and more success was noted with babies that still had a positive Ortolani sign (reduction clunk during examination). However success was achieved for 30% of infants when the hip was stuck out of the joint after the four week waiting period. This may be an alternative instead of closed reduction and cast when the initial attempt at the Pavlik harness is unsuccessful.
When to stop harness treatment is still controversial among physicians. Some wait until the ultrasound is normal and others take an x-ray or use other methods. Researchers from Nagoya, Japan studied x-rays after treatment of DDH with the Pavlik Harness. They determined that it’s best to continue treatment until the Acetabular Index is 30° of less. This is an x-ray measurement of the slope of the socket. It is often used by doctors to determine the amount of residual dysplasia. https://www.hipdysplasia.org/wp-content/uploads/2010/01/IHDI-Ortho-Presentation-Web.pdf
There was some bad news about long term surgery results. While most surgery for hip dislocation during childhood is successful the long term results may not be as good as doctors have expected. A report from the Mayo Clinic noted that one in five children that needed surgery required a total hip replacement by age 26 and two in five by age 35 years. Remember that these were children treated more than 20 years ago and some things have improved since then. For example, the children in this study were discovered at an older age than children needing surgery today. Also, pelvic osteotomy during the surgery gave better long term outcomes, and pelvic osteotomy is more common today. We still need to learn a lot and get better methods of treatment, but this report from the Mayo Clinic is a good reminder that the work of the International Hip Dysplasia Institute is very necessary.