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Should closed reduction of the dislocated hip be attempted after failed Pavlik harness treatment in developmental dysplasia of the hip?
| Content Provider | Europe PMC |
|---|---|
| Author | Arneill, Matthew Cosgrove, Aidan Robinson, Elaine |
| Copyright Year | 2021 |
| Abstract | AimsTo determine the likelihood of achieving a successful closed reduction (CR) of a dislocated hip in developmental dysplasia of the hip (DDH) after failed Pavlik harness treatment We report the rate of avascular necrosis (AVN) and the need for further surgical procedures.MethodsData was obtained from the Northern Ireland DDH database. All children who underwent an attempted closed reduction between 2011 and 2016 were identified. Children with a dislocated hip that failed Pavlik harness treatment were included in the study. Successful closed reduction was defined as a hip that reduced in theatre and remained reduced. Most recent imaging was assessed for the presence of AVN using the Kalamchi and MacEwen classification.ResultsThere were 644 dislocated hips in 543 patients initially treated in Pavlik harness. In all, 67 hips failed Pavlik harness treatment and proceeded to arthrogram (CR) under general anaesthetic at an average age of 180 days. The number of hips that were deemed reduced in theatre was 46 of the 67 (69%). A total of 11 hips re-dislocated and underwent open reduction, giving a true successful CR rate of 52%. For the total cohort of 67 hips that went to theatre for arthrogram and attempted CR, five (7%) developed clinically significant AVN at an average follow-up of four years and one month, while none of the 35 hips whose reduction was truly successful developed clinically significant AVN.ConclusionThe likelihood of a successful closed reduction of a dislocated hip in the Northern Ireland population, which has failed Pavlik harness treatment, is 52% with a clinically significant AVN rate of 7%. As such, we continue to advocate closed reduction under general anaesthetic for the hip that has failed Pavlik harness.Cite this article: Bone Jt Open 2021;2(8):594–598. |
| Related Links | https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC8384449&blobtype=pdf |
| Journal | Bone & Joint Open [Bone Jt Open] |
| Volume Number | 2 |
| PubMed Central reference number | PMC8384449 |
| Issue Number | 8 |
| PubMed reference number | 34351213 |
| e-ISSN | 26331462 |
| DOI | 10.1302/2633-1462.28.bjo-2021-0088.r1 |
| Language | English |
| Publisher | The British Editorial Society of Bone & Joint Surgery |
| Publisher Date | 2021-08-01 |
| Publisher Place | London |
| Access Restriction | Open |
| Rights License | This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/ © 2021 Author(s) et al. |
| Subject Keyword | Closed Reduction Pavlik Developmental dysplasia of the hip closed reductions dislocated hips Pavlik harness developmental dysplasia of the hip (DDH) hips avascular necrosis open reduction anaesthetic hip spica adductor tenotomy |
| Content Type | Text |
| Resource Type | Article |
| Subject | Orthopedics and Sports Medicine Surgery |
