title: Avascular necrosis rate in early reduction after failed Pavlik harness treatment of developmental dysplasia of the hip.
abstract: Our hypothesis is that hips with developmental dysplasia (DDH), which fail Pavlik harness treatment and are reduced within 3 months of age, have a low rate of avascular necrosis (AVN). Inclusion criteria are as follows: diagnosis of DDH within 2 months of birth, failure of reduction or stabilization by Pavlik harness treatment, surgical reduction of the hip advised to be performed within 3 months of age, and follow-up for Salter criteria of AVN. Twenty-one consecutive cases (35 hips) met the inclusion criteria. Nineteen cases (31 hips) were initially reduced within 3 months of age, and none of these cases developed AVN. After Pavlik harness failure, initial closed reduction was achieved in 33 (94%) of 35 hips, and open reduction required in 2 (6%) of 35 hips. At latest follow-up, one (3%) of 35 hips had AVN. At the time of reporting, 1 (3%) of the 35 hips has required an additional procedure (Pemberton osteotomy) for residual dysplasia. There were 2 outlier cases (4 hips) in which the parents delayed the reduction and 1 case developed unilateral AVN, which was reduced after the proximal femoral ossification center developed at 7 months of age. The data presented in the current study support our hypothesis.
authors.affiliation: Department of Orthopedics, Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA.
authors.forename: Hakan
authors.initials: H
authors.lastname: Senaran
authors.forename: J Richard
authors.initials: JR
authors.lastname: Bowen
authors.forename: H Theodore
authors.initials: HT
authors.lastname: Harcke
mesh_terms: D001848:Bone Diseases, Developmental / Q000150:complications / Q000601:surgery* / Q000628:therapy; D001915:Braces; D005260:Female; D005271:Femur Head Necrosis / Q000453:epidemiology* / Q000209:etiology; D006621:Hip Joint; D006801:Humans; D007223:Infant; D007592:Joint Diseases / Q000150:complications / Q000601:surgery* / Q000628:therapy; D008297:Male; D013997:Time Factors