title: Evaluation of Brace Treatment for Infant Hip Dislocation in a Prospective Cohort: Defining the Success Rate and Variables Associated with Failure.
abstract: BACKGROUND
  The use of a brace has been shown to be an effective treatment for hip dislocation in infants; however, previous studies of such treatment have been single-center or retrospective. The purpose of the current study was to evaluate the success rate for brace use in the treatment of infant hip dislocation in an international, multicenter, prospective cohort, and to identify the variables associated with brace failure.
  
  
  METHODS
  All dislocations were verified with use of ultrasound or radiography prior to the initiation of treatment, and patients were followed prospectively for a minimum of 18 months. Successful treatment was defined as the use of a brace that resulted in a clinically and radiographically reduced hip, without surgical intervention. The Mann-Whitney test, chi-square analysis, and Fisher exact test were used to identify risk factors for brace failure. A multivariate logistic regression model was used to determine the probability of brace failure according to the risk factors identified.
  
  
  RESULTS
  Brace treatment was successful in 162 (79%) of the 204 dislocated hips in this series. Six variables were found to be significant risk factors for failure: developing femoral nerve palsy during brace treatment (p = 0.001), treatment with a static brace (p < 0.001), an initially irreducible hip (p < 0.001), treatment initiated after the age of 7 weeks (p = 0.005), a right hip dislocation (p = 0.006), and a Graf-IV hip (p = 0.02). Hips with no risk factors had a 3% probability of failure, whereas hips with 4 or 5 risk factors had a 100% probability of failure.
  
  
  CONCLUSIONS
  These data provide valuable information for patient families and their providers regarding the important variables that influence successful brace treatment for dislocated hips in infants.
  
  
  METHODS
  Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Rady Children's Hospital, San Diego, California vupasani@rchsd.org.
authors.forename: Vidyadhar V
authors.initials: VV
authors.lastname: Upasani
authors.affiliation: Rady Children's Hospital, San Diego, California.
authors.forename: James D
authors.initials: JD
authors.lastname: Bomar
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Travis H
authors.initials: TH
authors.lastname: Matheney
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Wudbhav N
authors.initials: WN
authors.lastname: Sankar
authors.affiliation: British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Kishore
authors.initials: K
authors.lastname: Mulpuri
authors.affiliation: Arnold Palmer Hospital for Children, Orlando, Florida.
authors.forename: Charles T
authors.initials: CT
authors.lastname: Price
authors.affiliation: Hilton Head Island, South Carolina.
authors.forename: Colin F
authors.initials: CF
authors.lastname: Moseley
authors.affiliation: Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kelley
authors.affiliation: Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Unni
authors.initials: U
authors.lastname: Narayanan
authors.affiliation: University of Southampton, Southampton, Hampshire, United Kingdom.
authors.forename: Nicholas M P
authors.initials: NM
authors.lastname: Clarke
authors.affiliation: Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: John H
authors.initials: JH
authors.lastname: Wedge
authors.affiliation: Centro Médico ABC Santa Fe, Mexico City, Tlaxcala, Mexico.
authors.forename: Pablo
authors.initials: P
authors.lastname: Castañeda
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts.
authors.forename: James R
authors.initials: JR
authors.lastname: Kasser
authors.affiliation: Department of Orthopaedic Surgery, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Foster
authors.affiliation: Arnold Palmer Hospital for Children, Orlando, Florida.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Herrera-Soto
authors.affiliation: Department of Orthopaedic Surgery, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Cundy
authors.affiliation: Department of Orthopaedic Surgery, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Williams
authors.affiliation: Rady Children's Hospital, San Diego, California.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Mubarak
mesh_terms: D001915:Braces; D005260:Female; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging / Q000628:therapy*; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D017211:Treatment Failure; D016896:Treatment Outcome; D014463:Ultrasonography