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Length of treatment and ultrasound timing in infants with developmental dysplasia of the hip

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Abstract

Purpose

Developmental dysplasia of the hip (DDH) joint is a complex condition that may lead to severe problems. Ultrasound scan (USS) in the first four-to-six weeks of life is considered the gold-standard for diagnosis while the Pavlik harness (PH) is a widely utilized method as first-line treatment. The purpose of this study is to compare clinical outcomes of infants with DDH in relation to the timing and frequency of USS following application of the PH.

Methods

Retrospective data were collected over a 5-year period from February 2017 to February 2022. We included patients who underwent the first USS post-diagnosis and PH application in two, three, four and six weeks. Two-hundred-twenty-five patients were included and divided in four groups according to timing of the first follow-up: week-2, n = 13; week-3, n = 66; week-4, n = 95; and week-6, n = 51. For every patient Graf classification, treatment length and number of follow-ups were documented.

Results

Week-3 and week-4 groups displayed a statistically significant shorter treatment length compared to week-6 group (p value < 0.001), while also demonstrating a lower number of sonographic follow-ups per patient compared to both week-6 (p value < 0.001) and week-2 (p value = 0.002 vs week-3; p value < 0.001 vs week 4). Week-4 group presented the highest treatment completion (56%) on first visit post-diagnosis. Conservative treatment with PH failed in 1.8% (4/225) and displayed no significant difference among all subgroups.

Conclusions

Differences in timing of first USS post-DDH diagnosis and initiation of treatment can lead to discrete outcomes with implications to the clinical outcome and cost effectiveness.

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Acknowledgements

We would like to thank Princess Alexandra Hospital Library for providing us with access to the literature databases, as well as assisting us with the retrieval of multiple full texts articles.

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Authors and Affiliations

  1. Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, CM20 1QX, UK

    Christos Georgios Dragonas, Lina Abbakr, Narmeen Taha & Dimitrios Manoukian

  2. Whipps Cross Hospital, Barts Health Trust, London, UK

    Eleni Kottaridou

  3. The Royal London Hospital, Barts Health Trust, London, UK

    Themistoklis Vampertzis & Dimitrios Manoukian

  4. School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Themistoklis Vampertzis

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  1. Christos Georgios Dragonas
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Correspondence to Christos Georgios Dragonas.

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Dragonas, C.G., Kottaridou, E., Vampertzis, T. et al. Length of treatment and ultrasound timing in infants with developmental dysplasia of the hip. Eur J Orthop Surg Traumatol 34, 1079–1086 (2024). https://doi.org/10.1007/s00590-023-03771-z

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