Comparison and evaluation of the conservative treatment methods in developmental hip dysplasia

Introduction and Aim: Early diagnosis and treatment is very important in developmental hip dysplasia(DHD). Conservative treatment, close and open reductions are the main treatment modalities are used in early diagnosed patients. In this study, we aimed to evaluate and compare results conservative treatment methods in DHD. Material and method: In this study patients were diagnosed with developmental hip dysplasia in Karadeniz Technical University Orthopaedics and Traumatology department, between the years 2000 to 2019 and treated with conservative methods evaluated retrospectively. Ultrasonographically classified Graf 3, Graf 4 and radiographically dislocated hips excluded because of abduction orthosis doesn't take place in dislocated hip treatment. And also patients who could not be followed with enough period and proper documentation, followed in another medical center, had teratogenic or neurologic etiology to cause hip dysplasia were also excluded. 361 hips of the 261 patients who were suitable to the objective included. 156 hips of the 115 patients treated with Pavlik harness and 107 hips of the 76 patients treated with abduction orthosis. 98 hips of the 70 patients were older than 6 months were diagnosed with residual acetabular dysplasia and treated with abduction orthosis. Patients involved in this study classified with Graf classification. Patients who hadn't got ultrasonographic images classified with radiological modalities and assessed with direct radiographies. Shenton-menard line continuity, acetabular index angle and location of the femoral head according to the Perkins quadrants evaluated. First admission, first year, end of the the treatment and second year acetabular index angles and in the long term follow up patients third year, fifth year and last admission acetabular index angles measured. Last control sharp angles measured in Patients followed up for 4 years and longer. Findings: 224 patients are involved in this study were female(85.8%) and 37 patients were male(14.2%). 102 patients(39.2%) had bilateral, 92 patients(35.2%) had left sided and 67 patients(25.6)had right sided developmental hip dysplasia. Patients treated with Pavlik harness in 0 to 6 months were classified as group 1, treated with abduction orthosis in 0 to 6 months classified as group 2 and treated with abduction orthosis older than 6 months classified as group 3. In group 1 average Pavlik harness beginning time was 3±0.8 months(1-6), average harness using time was 3±1.1 months (1-7), abduction orthosis beginning time was 6±1 months(4-9), abduction orthosis using time 12±1.3months, treatment time was 14±1.9 months(8-21) and follow up time was 40±22.8months (21-132). 84.6 percent clinical and 76.5 percent radiological success rates have been achieved in this group. In group 2 assessed that the average abduction orthosis beginning time was 4±0.8 (2-5), abduction orthosis using time was 12±4.74 months (1-18), part time orthosis using was 6±1.6 months(1-10), follow up time was 36±33 months (22-156) . 84.1 percent clinical and 76.7 percent radiological success rates have been achieved in group 2. In group 3 assessed the average abduction orthosis beginning time was 8±2.6 months (6-17), abduction orthosis using time was 11±2.4 months (5-16), part time orthosis using time was 6±2.2 months(3-12), follow up time was 55±33(23-168) months. Radiological success rate of the patients in group 3 at the second year check up measured as 78.6% and in the long term follow ups this rate raised to the 93%. comparison of the radiological success rates of group 1 and group 2 did not reveal a significant difference. But the group 3 success rates when they compared with the up to dated literature thaproved us the clinical accomplishment. Results: In our study we observed abduction orthosis is a treatment modality which is as effective as Pavlik harness in patients 0 to 6 months, ultrasonographically classified as graf type 2a, 2b, 2c and graf type d and radiologically diagnosed subluxated and dysplastic hips. Previous Pavlik harness usage was detected ineffective in patients with acetabular dysplasia. Abduction orthosis usage in residual acetabular dysplasia treatment was detected as an effective method. According to the age groups of the patients included in our study, we found that the age of onset of abduction orthosis had no effect on acetabular dysplasia.