Spontaneous recovery in the majority of stable dysplastic hips treated with active surveillance.

IF 4.9 1区医学 Q1 ORTHOPEDICS

Bone & Joint Journal Pub Date : 2025-02-01 DOI:10.1302/0301-620X.107B2.BJJ-2024-0331.R1

Wesley W E S Theunissen, Marieke C van der Steen, Thom Klerkx, Charlotte Schonck, Arnold T Besselaar, Florence Q M P van Douveren, Jaap J Tolk

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引用次数: 0

Abstract

Aims: Worldwide controversy exists on the optimal treatment of stable dysplastic hips. The most common treatment options are abduction brace treatment and active surveillance. The primary aim of this study was to assess the effect of active surveillance in stable hip dysplasia, by investigating the percentage of Graf IIb stable dysplastic hips that recover spontaneously without abduction brace treatment. The second aim was to identify prognostic factors for spontaneous recovery of stable dysplastic hips.

Methods: A single-centre, prospective cohort study was conducted at the Máxima Medical Center between 1 March 2019 and 1 March 2023. Infants aged three to 4.5 months at the first outpatient clinic visit, diagnosed with Graf IIb hip dysplasia, and treated with active surveillance were included. Spontaneous recovery was defined as infants who had a normalized hip on ultrasound (α-angle ≥ 60°) after six weeks of active surveillance without receiving abduction brace treatment. Baseline infant characteristics and ultrasound measurements were used as potential predictor variables for spontaneous recovery in logistic regression analyses.

Results: A total of 508 infants with Graf IIb stable dysplastic hips were included. Overall, 473 infants (93.1%) recovered spontaneously with active surveillance. Of the remaining 35 infants, 25 infants (4.9%) received six weeks and ten infants (2.0%) received 12 weeks of additional Pavlik harness treatment until hip normalization. In univariate and multivariate analyses, an impaired hip abduction was negatively associated (OR 0.43 (95% CI 0.20 to 0.93); p = 0.033) and being a firstborn child positively associated (OR 2.20 (95% CI 1.04 to 4.63); p = 0.042) with spontaneous recovery.

Conclusion: The majority of Graf IIb stable dysplastic hips recover spontaneously in infants aged three to 4.5 months after six weeks of active surveillance. We recommend active surveillance with ultrasound as primary treatment for these infants. However, care must be taken with active surveillance in infants with a limited hip abduction.

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主动监测治疗的大多数稳定型发育不良髋的自发恢复。

目的：稳定性发育不良髋的最佳治疗方法在世界范围内存在争议。最常见的治疗选择是外展支架治疗和主动监测。本研究的主要目的是通过调查未经外展支架治疗的Graf IIb型稳定发育不良髋关节自发恢复的百分比，来评估主动监测对稳定型髋关节发育不良的影响。第二个目的是确定稳定发育不良髋关节自发恢复的预后因素。方法：2019年3月1日至2023年3月1日在Máxima医学中心进行了一项单中心前瞻性队列研究。首次门诊就诊时年龄为3 - 4.5个月、诊断为Graf ii型髋关节发育不良并接受主动监测的婴儿被纳入研究对象。自发恢复定义为婴儿在主动监测6周后，髋关节在超声检查（α-角≥60°）上正常（α-角≥60°），且未接受外展支架治疗。在logistic回归分析中，基线婴儿特征和超声测量被用作自发恢复的潜在预测变量。结果：共纳入508名患有Graf IIb型稳定发育不良髋关节的婴儿。总体而言，473名婴儿（93.1%）在积极监测下自行康复。在剩下的35名婴儿中，25名婴儿（4.9%）接受了6周的额外治疗，10名婴儿（2.0%）接受了12周的额外治疗，直到髋关节正常化。在单因素和多因素分析中，髋关节外展受损与髋关节外展呈负相关(OR 0.43 (95% CI 0.20 ~ 0.93)；p = 0.033)和头胎呈正相关(OR 2.20 (95% CI 1.04 ~ 4.63)；P = 0.042)，自发恢复。结论：在3 - 4.5个月大的婴儿中，经过6周的主动监测后，大多数Graf IIb型稳定发育不良髋自行恢复。我们建议对这些婴儿进行超声主动监测作为主要治疗。然而，对于髋关节外展受限的婴儿，必须注意主动监测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bone & Joint Journal ORTHOPEDICS-SURGERY

CiteScore

9.40

自引率

10.90%

发文量

318

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