TREATMENT OF THE CONGENITAL DISLOCATION OF THE HIP IN NEWBORN WITH THE PAVLIK BANDAGE IN THE PERIOD 1995 TO 2006

Abstract

Introduction: 1986 we started with ultrasound screening for congenital dislocation of the hip (CDH) in all newborn children from our hospital. In 1995 an regime was investigated we developed out of our expieriences of the previous years and started a prospective study.

Material and methods: In the period 1995 to 2006 we did ultrasound screening in newborn babies within the first week of life. There were 14744 ultrasound checkups in 7372 children. Following the classification of Graf we had 7213 children with stage Ia,Ib or IIa. In 159 children (2,15%) we saw a ultrasound measurement stage IIc or worse (D,IIIa/b; IV a/b) which was an indication for treatment with the Pavlik bandage. Over all we treated 203 dysplastic hips with our regime. By dedecting a congenital dislocated hip we applyed the Pavlik harness immediately after diagnosis in 110 degrees of flection an 45 degrees of abduction. The fist controll reviewing the compliance of the parents and the setting of the bandage was 10 to 14 days after starting treatment. Every 10 to 14 days we did bandage checks combined with ultrasound controlls. We stopped treatment with the pavlik harness when the ultrasound showed a mature, well developed picture of both hips compared to Graf stage Ia/b.

Results: We treated 159 newborn with 203 dislocated hips. There were 131 (82.4%) female an 28 (17.6)% male patients. 100 right (49.5%) and in 103 left (50.5%) hips. The distribution following Graf classification were 150 for typ IIc (73.9%), 18 for type D (8.9%), 31 for type IIIa/b (15.3%) and 4 type IVa/b (1.9%). Summerizing there were 150 hips, stage IIc (73,9%), to be at risk to develope an luxation, but 53 (26,1%) hips were already luxated at the moment of birth. The average treatment time over all was 53 days (7,6 (3–26) weeks). Subdividing the groups the treatment period for stage IIc was in mean 7.6 weeks, for stage D 7.1 weeks, for stage III a/b 9.5 weeks and for stage IV a/b 9 week. We had a lost to follow up in 4 (1,81%) patients (3 times compliance problems with the parents at stage II a in both sides). Once we had to treat with a so called Fettweiss-cast after one week of therapy because the baby was to small for the bandage but in the other cases there was no need für additional methodes of treatment. At no time we ever had a degradation of the disease. Furthermore we had no necrosis of the femoral head in our study population.

Conclusion: The treatment with the Pavlik bandage of the CDH in every stage in newborn was possible and showed good result in 203 hips. To establish a standardised therapy you have to do an area-wide ultrasound screening as well as an consistently follow up of your therapy.