A comprehensive nonoperative treatment protocol for developmental dysplasia of the hip in infants.

Autor:	Bradley CS; Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada., Verma Y; Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada., Maddock CL; Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada., Wedge JH; Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada.; Department of Surgery, University of Toronto, Toronto, Canada., Gargan MF; Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada.; Department of Surgery, University of Toronto, Toronto, Canada., Kelley SP; Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada.; Department of Surgery, University of Toronto, Toronto, Canada.
Jazyk:	angličtina
Zdroj:	The bone & joint journal [Bone Joint J] 2023 Aug 01; Vol. 105-B (8), pp. 935-942. Date of Electronic Publication: 2023 Aug 01.
DOI:	10.1302/0301-620X.105B8.BJJ-2023-0149.R1
Abstrakt:	Aims: Brace treatment is the cornerstone of managing developmental dysplasia of the hip (DDH), yet there is a lack of evidence-based treatment protocols, which results in wide variations in practice. To resolve this, we have developed a comprehensive nonoperative treatment protocol conforming to published consensus principles, with well-defined a priori criteria for inclusion and successful treatment. Methods: This was a single-centre, prospective, longitudinal cohort study of a consecutive series of infants with ultrasound-confirmed DDH who underwent a comprehensive nonoperative brace management protocol in a unified multidisciplinary clinic between January 2012 and December 2016 with five-year follow-up radiographs. The radiological outcomes were acetabular index-lateral edge (AI-L), acetabular index-sourcil (AI-S), centre-edge angle (CEA), acetabular depth ratio (ADR), International Hip Dysplasia Institute (IHDI) grade, and evidence of avascular necrosis (AVN). At five years, each hip was classified as normal (< 1 SD), borderline dysplastic (1 to 2 SDs), or dysplastic (> 2 SDs) based on validated radiological norm-referenced values. Results: Of 993 infants assessed clinically and sonographically, 21% (212 infants, 354 abnormal hips) had DDH and were included. Of these, 95% (202 infants, 335 hips) successfully completed bracing, and 5% (ten infants, 19 hips) failed bracing due to irreducible hip(s). The success rate of bracing for unilateral dislocations was 88% (45/51 infants) and for bilateral dislocations 83% (20/24 infants). The femoral nerve palsy rate was 1% (2/212 infants). At five-year follow-up (mean 63 months (SD 5.9; 49 to 83)) the prevalence of residual dysplasia after successful brace treatment was 1.6% (5/312 hips). All hips were IHDI grade I and none had AVN. Four children (4/186; 2%) subsequently underwent surgery for residual dysplasia. Conclusion: Our comprehensive protocol for nonoperative treatment of infant DDH has shown high rates of success and extremely low rates of residual dysplasia at a mean age of five years. Competing Interests: None declared. (© 2023 Authors et al.)
Databáze:	MEDLINE
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