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Prognostic factors for failed Pavlik harness treatment in infants with developmental dysplasia of the hip: a retrospective cohort study

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Abstract

Purpose

Pavlik harness treatment is the most common treatment in newborns diagnosed with developmental dysplasia of the hip (DDH). The success rates and predictors for failure have been debated over the last decade. In this study, we explored our treatment failure rate and potential prognostic factors that could predict the failure of Pavlik harness (PH) treatment in patients with DDH.

Methods

Two hundred and sixty-five patients were treated with PH based on the Graf hip types of classification. Age, gender, first born status, family history, foot deformity, plagiocephaly, breech presentation, hip abduction, hip stability, Graf hip type, Galeazzi sign, bilateralism, and femoral nerve palsy were tested as predictors for failure in multivariate logistic regression mode. Success and failure were determined by the normalization of the hip based on the Graf hip classification.

Results

The failure rate of patients treated with Pavlik harness was 16.6% which is within the reported range of failure rate. The mean age of patients who were successfully treated was 6.73 weeks in comparison to 8.84 weeks for those who failed. Age, plagiocephaly, hip instability, Graf classification, and the development of femoral nerve palsy were found to be predictors for failure of PH treatment upon univariate analysis only. However, only the presence of Galeazzi sign, hip instability, high grades of Graf hip classification, and the development of femoral nerve palsy proved to be independent predictors for failed PH treatment upon multivariate logistic regression analysis.

Conclusions

Pavlik harness treatment is a successful treatment with an average success of 83.4%. Several independent predictors for failure of PH treatment have been identified. These include a positive Galeazzi sign, a frankly dislocated hip, Graf types III and IV, and the development of femoral nerve palsy.

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Data availability

Anonymous data is available on request.

Code availability

SPSS output data is available on request.

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Acknowledgements

We would like to thank our librarians at the above centers for obtaining some of the references that are used in the manuscript.

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Authors and Affiliations

  1. Medical School, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates

    Nada Abdulla & Amar Hassan Khamis

  2. Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates

    Maryam Ashoor, Ibrar Majid & Sattar Alshryda

  3. Stockport NHS Trust, Manchester, UK

    Nicholas Heinz & Vasileios Alexopoulos

  4. Royal Manchester Children Hospital, Manchester, UK

    Emmanouil Morakis

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  1. Nada Abdulla
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  8. Sattar Alshryda
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Nicholas Heinz, Vasileios Alexopoulos, Ibrar Majid, and Sattar Alshryda. Data cleaning and analysis were performed by Nada Abdulla, Maryam Ashoor, Sattar Alshryda, and Amar Hassan Khamis. The first draft of the manuscript was written by Nada Abdulla and Sattar Alshryda and refined by Ibrar Majid and Emmanouil Morakis, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sattar Alshryda.

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Abdulla, N., Ashoor, M., Heinz, N. et al. Prognostic factors for failed Pavlik harness treatment in infants with developmental dysplasia of the hip: a retrospective cohort study. International Orthopaedics (SICOT) 47, 2337–2345 (2023). https://doi.org/10.1007/s00264-023-05829-3

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