title: Treatment of Graf's ultrasound class III and IV hips using Pavlik's method.
abstract: When Pavlik introduced his method of treating congenital dislocation of the hip, he emphasized reducing the rate of osteonecrosis. Graf's method of sonographic evaluation afforded earlier accurate diagnosis and subsequent treatment of developmental dysplasia of the hip. To ascertain whether treatment duration, gender, age at diagnosis, clinical stability, and/or treatment onset correlate with the risk of osteonecrosis in Graf Type III or IV hips, we clinically and sonographically screened 18,067 neonates (36,134 hips) for developmental dysplasia of the hip over a 4-year period; 151 had Graf Type III or IV hips, and 78 of these were treated by us and had known outcomes. Of these 78 hips, 65 (0.18%) had Graf Type III and 13 (0.036%) had Graf Type IV hips. Sixteen of the 65 Type III hips (25%) reduced spontaneously. Using Pavlik's method, reduction was achieved in 46 of 65 (88.5%) Type III hips and eight of 13 Type IV hips. None of the hips treated exclusively by Pavlik's method developed osteonecrosis. Thus, the method achieves one of Pavlik's original goals of decreasing osteonecrosis incidence to close to zero.
  
  
  METHODS
  Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery B, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Peled
authors.forename: Viktor
authors.initials: V
authors.lastname: Bialik
authors.forename: Alexander
authors.initials: A
authors.lastname: Katzman
authors.forename: Mark
authors.initials: M
authors.lastname: Eidelman
authors.forename: Doron
authors.initials: D
authors.lastname: Norman
mesh_terms: D005260:Female; D006618:Hip Dislocation, Congenital / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008297:Male; D015997:Neonatal Screening; D009989:Orthotic Devices; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography