Luckshman Bavan, Thomas Lloyd, Lucy Llewellyn-Stanton, Maximillian Mifsud, Alpesh Kothari
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The mean age at treatment initiation was 7.0±4.5 weeks and mean treatment duration was 15.9±4.3 weeks. Overall, 27% and 19% of hips were found to have RAD at 2- (n=448) and 4-year (n=206) follow-up, respectively. The χ 2 test for independence demonstrated that the difference in the proportion of hips with RAD at both time points was significant ( P =0.032). Patients with RAD at 2 years were found to have been treated for longer ( P =0.028) and had lower alpha angles on final ultrasound assessment ( P <0.001). Patients with RAD at 4 years were older at initiation of treatment ( P =0.041), had lower alpha angles on final ultrasound assessment ( P <0.001) and were more likely to have had RAD at 2 years ( P <0.001). Multivariate analysis identified lower alpha angles on final ultrasound to be predictive for RAD at 2 years ( P =0.011), and presence of RAD at 2 years to be predictive for RAD at 4 years ( P <0.001).</p><p><strong>Conclusions: </strong>The risk of RAD beyond walking age in children successfully treated with Pavlik harness is not negligible. However, we observed that a significant proportion of children with RAD at 2-year follow-up had spontaneously improved without any intervention. This data suggests that routine long-term radiologic follow-up of children treated with Pavlik harness is necessary, and surgical intervention to address RAD should be delayed until at least 4 years of age.</p><p><strong>Level of evidence: </strong>Level III-case-control study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Residual Acetabular Dysplasia at Walking Age: A Study of 470 Hips Treated With Pavlik Harness.\",\"authors\":\"Luckshman Bavan, Thomas Lloyd, Lucy Llewellyn-Stanton, Maximillian Mifsud, Alpesh Kothari\",\"doi\":\"10.1097/BPO.0000000000002714\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>This study aims to report on the acetabular indices of walking age children following successful DDH treatment with Pavlik harness and investigate risk factors for residual acetabular dysplasia (RAD).</p><p><strong>Methods: </strong>We retrospectively reviewed the data for children treated for DDH at a single centre between 2015 and 2020. Acetabular indices (AI) measured on pelvic radiographs taken at 2- and 4-year follow-up visits were referenced against age-matched and sex-matched normal data. Values ≥90th percentile were considered to represent RAD.</p><p><strong>Results: </strong>A total of 305 children with 470 hips were suitable for inclusion. The mean age at treatment initiation was 7.0±4.5 weeks and mean treatment duration was 15.9±4.3 weeks. Overall, 27% and 19% of hips were found to have RAD at 2- (n=448) and 4-year (n=206) follow-up, respectively. The χ 2 test for independence demonstrated that the difference in the proportion of hips with RAD at both time points was significant ( P =0.032). Patients with RAD at 2 years were found to have been treated for longer ( P =0.028) and had lower alpha angles on final ultrasound assessment ( P <0.001). Patients with RAD at 4 years were older at initiation of treatment ( P =0.041), had lower alpha angles on final ultrasound assessment ( P <0.001) and were more likely to have had RAD at 2 years ( P <0.001). Multivariate analysis identified lower alpha angles on final ultrasound to be predictive for RAD at 2 years ( P =0.011), and presence of RAD at 2 years to be predictive for RAD at 4 years ( P <0.001).</p><p><strong>Conclusions: </strong>The risk of RAD beyond walking age in children successfully treated with Pavlik harness is not negligible. However, we observed that a significant proportion of children with RAD at 2-year follow-up had spontaneously improved without any intervention. 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引用次数: 0
摘要
背景：本研究旨在报告使用帕夫利克安全带成功治疗DDH后步行年龄儿童的髋臼指数，并调查残余髋臼发育不良（RAD）的风险因素：本研究旨在报告使用Pavlik背带成功治疗DDH后步行年龄儿童的髋臼指数，并调查残余髋臼发育不良（RAD）的风险因素：我们回顾性审查了2015年至2020年间在一家中心接受DDH治疗的儿童的数据。根据2年和4年随访时骨盆X光片上测量的髋臼指数（AI）与年龄和性别匹配的正常数据进行比对。结果：结果：共有 305 名患有 470 个髋关节的儿童适合纳入研究。开始治疗时的平均年龄为（7.0±4.5）周，平均治疗时间为（15.9±4.3）周。在2年（448例）和4年（206例）的随访中，分别发现27%和19%的髋关节有RAD。独立性的χ2检验表明，两个时间点的髋关节RAD比例差异显著（P=0.032）。2年后有RAD的患者接受治疗的时间更长（P=0.028），最终超声评估的α角更低（PC结论：在使用帕夫利克安全带成功治疗的儿童中，步行年龄之后出现 RAD 的风险不容忽视。然而，我们观察到，在两年的随访中，相当一部分患有 RAD 的儿童在没有任何干预措施的情况下自发得到了改善。这一数据表明，有必要对使用帕夫利克安全带治疗的儿童进行常规的长期放射学随访，而针对RAD的手术干预应至少推迟到4岁：证据等级：三级-病例对照研究。
Residual Acetabular Dysplasia at Walking Age: A Study of 470 Hips Treated With Pavlik Harness.
Background: This study aims to report on the acetabular indices of walking age children following successful DDH treatment with Pavlik harness and investigate risk factors for residual acetabular dysplasia (RAD).
Methods: We retrospectively reviewed the data for children treated for DDH at a single centre between 2015 and 2020. Acetabular indices (AI) measured on pelvic radiographs taken at 2- and 4-year follow-up visits were referenced against age-matched and sex-matched normal data. Values ≥90th percentile were considered to represent RAD.
Results: A total of 305 children with 470 hips were suitable for inclusion. The mean age at treatment initiation was 7.0±4.5 weeks and mean treatment duration was 15.9±4.3 weeks. Overall, 27% and 19% of hips were found to have RAD at 2- (n=448) and 4-year (n=206) follow-up, respectively. The χ 2 test for independence demonstrated that the difference in the proportion of hips with RAD at both time points was significant ( P =0.032). Patients with RAD at 2 years were found to have been treated for longer ( P =0.028) and had lower alpha angles on final ultrasound assessment ( P <0.001). Patients with RAD at 4 years were older at initiation of treatment ( P =0.041), had lower alpha angles on final ultrasound assessment ( P <0.001) and were more likely to have had RAD at 2 years ( P <0.001). Multivariate analysis identified lower alpha angles on final ultrasound to be predictive for RAD at 2 years ( P =0.011), and presence of RAD at 2 years to be predictive for RAD at 4 years ( P <0.001).
Conclusions: The risk of RAD beyond walking age in children successfully treated with Pavlik harness is not negligible. However, we observed that a significant proportion of children with RAD at 2-year follow-up had spontaneously improved without any intervention. This data suggests that routine long-term radiologic follow-up of children treated with Pavlik harness is necessary, and surgical intervention to address RAD should be delayed until at least 4 years of age.
期刊介绍：
Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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