Comparison of the effectiveness of the tübingen orthosis and the pavlik harness in conservative treatment of developmental hip dysplasia

Purpose: The aim of this study is to compare the success rates of using Tübingen orthosis and Pavlik harness in patients diagnosed with DDH according to parental education levels. Material and Method: In this study, the conservative treatments and follow-ups of patients with DDH who applied to the Orthopedics and Traumatology clinic of Harran University Faculty of Medicine Hospital between May 2022 and December 2023 were prospectively examined. Patients younger than 6 months who were treated and followed up by our clinic within the specified date range were included in the study. After the inclusion and exclusion criteria were applied, a total of 48 patients and 70 hips were included in the study. The parents of the patients were given an information and practice before the treatment initiation. The practice was given by the same physician and for an equal period of time. Hips USG was applied for all patients according to Graf method. USG follow-up was repeated 3 times, once every 2 weeks. Graf scale follow-up was performed with USG and IHDI classification was followed up with pelvic anterior-posterior radiography. Patients were invited to the clinic every week and follow-up and records were taken for appropriate use. In addition to the caregiver's own statement at weekly patient check-ups, the location of the lines used in the Pavlik harness and the strings used to indicate the number of beads in the Tübingen orthosis, abduction and flexion angles, whether the hips were symmetrical, and compliance with daily usage times were determined as criteria for determining appropriate use. Results: Our study consisted of a total of 48 patients and 70 hips. Of these 48 patients, 5 (10.4%) were male and 43 (89.5%) were female. 4 (8.3%) of our patients were right, 22 (45.8%) were left and 22 (45.8) were bilateral. There was a history of swaddling use in 27 (56.3%) of 48 patients. There was a history of consanguinity between the parents in 24 (50%) of 48 patients. There was a history of DDH in the family of 24 (50%) of the patients. In terms of maternal ethnicity, 25 (52.1%) were Arab, 20 (41.7%) were Kurdish and 3 (6.3%) were Turkish. In terms of father ethnicity, 24 (50.0%) were Arab, 20 (41.7%) were Kurdish, and 4 (8.3%) were Turkish. 32 (36.8%) had a family history of DDH. As a result of the evaluation of the parental education levels of 48 patients, 14 (29.2%) of the 48 mothers were illiterate, 14 (29.2%) were primary school graduates, 11 (22.9%) were secondary school graduates, 4 (8.3%) were high school graduates, and 5 (10.4%) were undergraduate graduates. Of the 48 fathers, 26 (54.2%) were primary school graduates, 12 (25%) were secondary school graduates, 4 (8.3%) were high school graduates, and 6 (12.5%) were undergraduate graduates. It was determined that 3 (47%) of the mothers of the 7 patients who failed the treatment were secondary school graduates, 2 (28%) were illiterate, and 1 (14%) had a bachelor's degree. It was determined that 3 (47%) of their fathers were primary school graduates, 2 (28%) were secondary school graduates, and 2 (14%) were high school graduates. We found that 35 (97.2%) of the 36 hips using the Tübingen orthosis and 28 (82.3%) of the 34 hips using the Pavlik harness were successful. We also found that although there was no statistically significant difference in the appropriate use of abduction devices in the first two weeks, there was a statistically significant difference in the following weeks and that there was a correlation between the patients who did not use them appropriately and the patients who failed. All of the patients who did not use them appropriately and failed were patients who used the Pavlik harness. Conclusion: In this study, we concluded that compliance with treatment, parental education level, treatment process and abduction device selection are effective in the use of abduction devices. We think that education should be repeated during the treatment process and that it should be ensured that it is understood. We also concluded that the ease of use and application accuracy between the two devices according to the level of education are in favor of the Tübingen orthosis. Key Words: Pavlik harness, Tübingen orthosis, pavlik harness compliance, dysplasia, parent education