Radiographic prediction of the results of long-term treatment with the Pavlik harness for developmental dislocation of the hip.
In 1957, Pavlik introduced the Pavlik harness as a useful treatment for developmental dislocation of the hip (DDH), and subsequent studies have documented favorable outcomes among patients treated with this device. However, there are only a few articles reporting how early radiographic measurements can be used to determine the prognosis after treatment with the Pavlik harness. In this study, 217 hips from 192 patients whose DDH treatment with the Pavlik harness was initiated before they were 6 months old and whose follow-up lasted at least 14 years (rate, 63.8%) were analyzed using measurements from radiographs taken immediately before and after harness treatment, and at 1, 2, and 3 years of age. Severin's classification at the final follow-up was I or II in 71.9% and III or IV in 28.1% of the hips, respectively. Avascular necrosis of the femoral head (AVN) was seen in 10% of the hips. Stepwise multiple regression analysis was performed to retrospectively determine whether any radiographic factors were related to the final classification as Severin I/II or III/IV. Receiver operating characteristic (ROC) curves were drawn for these factors, and a Wiberg OE angle (Point O was the middle point of the proximal metaphyseal border of the femur) of 2 degrees on the 3-year radiographs was found to be the most useful screening value for judging the acetabular development of DDH cases after treatment with a Pavlik harness, with a sensitivity of 71% a specificity of 93%, and a likelihood ratio of 10.1.
Ohmori
Takao
T
Department of Orthopaedic Surgery, Kochi Health Sciences Center, Kochi 781-8555, Japan.
Endo
Hirosuke
H
Mitani
Shigeru
S
Minagawa
Hiroshi
H
Tetsunaga
Tomonori
T
Ozaki
Toshifumi
T
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006618:Hip Dislocation, Congenital / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D009989:Orthotic Devices; D011379:Prognosis; D012372:ROC Curve; D011859:Radiography; D016896:Treatment Outcome