title: Difficult-to-treat Ortolani-positive hip: improved success with new treatment protocol.
abstract: BACKGROUND
  The aim of this paper was to review the outcomes of treatment of dislocated but reducible (Ortolani-positive) hips.
  
  
  METHODS
  A comparative retrospective review was conducted of all patients aged younger than 6 months who presented for treatment of developmental dysplasia of the hip for two 10-year periods. The inclusion criteria consisted of a clinical evaluation documenting Ortolani-positive examination, no previous treatment, and an initial treatment with Pavlik harness only. Patients with insufficient follow-up, neuromuscular disease, provocative dislocatable hips, or dislocated but not reducible hips were excluded. In group 1 (1984-1994), treatment involved initiation of Pavlik harness and parental education at the time of initial diagnosis. Group 2 (1997-2007) was treated the same as group 1 with the addition of serial orthopaedic office-based ultrasound examinations and use of a hip abduction orthosis in hips remaining unstable after 3 weeks in the Pavlik harness. Records were assessed for successful achievement and maintenance of hip reduction, need for and type of further treatment, and development of avascular necrosis.
  
  
  RESULTS
  In group 1, the mean time of follow-up was 28 months. Forty-four (85%) of 52 hips were treated successfully. Eight patients required further operative treatment. In group 2, the mean follow-up to the final evaluation was 34 months. Forty-one (93%) of 44 hips were treated successfully. Three hips required further treatment. There were no documented cases of avascular necrosis in patients treated for orthoses only in either group.
  
  
  CONCLUSIONS
  In 1994, we presented a series of 52 Ortolani-positive hips (group 1) with a success rate of reduction of 85%. Now, our protocol for treating Ortolani-positive hips has evolved to include serial orthopaedic office-based ultrasound in all patients and use of a hip abduction orthosis in hips remaining unstable after 3 weeks in a Pavlik harness. Three previous studies at major centers reported successful reduction in only 63% to 71%. In group 2, our current success rate of 93% exceeds that previously reported by us and is significantly greater than these 3 previous studies (all P < 0.006). Furthermore, our current treatment module has decreased our rate of open reduction from 10% in group 1 to 5% in group 2. LEVEL OF RELEVANCE: Therapeutic study, level 3.
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL, USA.
authors.forename: Vineeta T
authors.initials: VT
authors.lastname: Swaroop
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Mubarak
mesh_terms: D001915:Braces; D005260:Female; D005271:Femur Head Necrosis / Q000453:epidemiology / Q000209:etiology; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009989:Orthotic Devices; D010290:Parents / Q000193:education; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography