6 Compared with 12 Weeks Treatment in the Von Rosen Splint is Sufficient for Barlow and Ortolani Positive Hips: a Comparative Study of 237 Neonates

Overview

Journal Acta Orthop

Specialty Orthopedics

Date 2023 Jun 22

PMID 37345418

Authors

Adam Sand

Carl Johan Tiderius

Henrik Duppe

Daniel Wenger

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: At our institution, newborns with Barlow or Ortolani positive hips have been treated for 12 weeks with the von Rosen abduction splint until 2012 when the treatment length was halved. We investigate whether acetabular development at 12 months of age and complications differ between hips treated with the von Rosen splint for 6 compared with 12 weeks.

Patients And Methods: 99 patients were included in the 6-week program and 138 patients in the 12-week program. We measured the acetabular index (AI) on standard anteroposterior pelvic radiographs taken at 12 months of age. Medical records were reviewed for complications and additional treatments until age 12 months. We used non-inferiority testing with an equivalence margin of 1° with a 95% confidence interval (CI) to compare the 2 groups.

Results: The mean AI at 12 months in the 6-week group was 25° (CI 24-26) compared with 25° (CI 25-26) in the 12-week group. Non-inferiority was demonstrated for the 6-week program: -0.2° (CI -1.1 to 0.7). In the 6-week group, 8 patients received additional treatment, including 1 hip dislocation that occurred between 6 weeks and 3 months. There were no additional treatments or complications in the 12-week group.

Conclusion: AI was equal at 12 months of age for patients treated for 6 compared with 12 weeks in the von Rosen splint. The hip dislocation which occurred indicates that follow-up around 3 months of age is indicated.

References

VON ROSEN S . Early diagnosis and treatment of congenital dislocation of the hip joint. Acta Orthop Scand. 1956; 26(2):136-55. View

Boniforti F, Fujii G, Angliss R, Benson M . The reliability of measurements of pelvic radiographs in infants. J Bone Joint Surg Br. 1997; 79(4):570-5. DOI: 10.1302/0301-620x.79b4.7238. View

Thallinger C, Pospischill R, Ganger R, Radler C, Krall C, Grill F . Long-term results of a nationwide general ultrasound screening system for developmental disorders of the hip: the Austrian hip screening program. J Child Orthop. 2014; 8(1):3-10. PMC: 3935031. DOI: 10.1007/s11832-014-0555-6. View

Wilkinson A, Sherlock D, Murray G . The efficacy of the Pavlik harness, the Craig splint and the von Rosen splint in the management of neonatal dysplasia of the hip. A comparative study. J Bone Joint Surg Br. 2002; 84(5):716-9. DOI: 10.1302/0301-620x.84b5.12571. View

Sahlstrand T, Malmgren N, AHLGREN S, Helgason H, Nilsson J . Management of neonatal hip instability: an analysis of the efficiency in a consistent treatment program. J Pediatr Orthop. 1985; 5(5):540-5. View

BARLOW T . Congenital dislocation of the hip in the newborn. Proc R Soc Med. 1966; 59(11 Part 1):1103-6. PMC: 1901330. View

von Kries R, Ihme N, Oberle D, Lorani A, Stark R, Altenhofen L . Effect of ultrasound screening on the rate of first operative procedures for developmental hip dysplasia in Germany. Lancet. 2003; 362(9399):1883-7. DOI: 10.1016/S0140-6736(03)14957-4. View

Wenger D, Samuelsson H, Duppe H, Tiderius C . Early treatment with the von Rosen splint for neonatal instability of the hip is safe regarding avascular necrosis of the femoral head: 229 consecutive children observed for 6.5 years. Acta Orthop. 2016; 87(2):169-75. PMC: 4812080. DOI: 10.3109/17453674.2015.1126158. View

Lauge-Pedersen H, Gustafsson J, Hagglund G . 6 Weeks with the von Rosen splint is sufficient for treatment of neonatal hip instability. Acta Orthop. 2006; 77(2):257-61. DOI: 10.1080/17453670610045993. View

10.

DAHLSTROM H, OBERG L, FRIBERG S . Sonography in congenital dislocation of the hip. Acta Orthop Scand. 1986; 57(5):402-6. DOI: 10.3109/17453678609014757. View

11.

Wenger D, Duppe H, Tiderius C . Acetabular dysplasia at the age of 1 year in children with neonatal instability of the hip. Acta Orthop. 2013; 84(5):483-8. PMC: 3822134. DOI: 10.3109/17453674.2013.850009. View

12.

Kalamchi A, MacEwen G . Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1980; 62(6):876-88. View

13.

Albinana J, Dolan L, Spratt K, Morcuende J, Meyer M, Weinstein S . Acetabular dysplasia after treatment for developmental dysplasia of the hip. Implications for secondary procedures. J Bone Joint Surg Br. 2004; 86(6):876-86. DOI: 10.1302/0301-620x.86b6.14441. View

14.

Hahn S . Understanding noninferiority trials. Korean J Pediatr. 2012; 55(11):403-7. PMC: 3510268. DOI: 10.3345/kjp.2012.55.11.403. View

15.

Wenger D, Duppe H, Nilsson J, Tiderius C . Incidence of Late-Diagnosed Hip Dislocation After Universal Clinical Screening in Sweden. JAMA Netw Open. 2019; 2(11):e1914779. PMC: 6902841. DOI: 10.1001/jamanetworkopen.2019.14779. View

16.

Ortolani M . Congenital hip dysplasia in the light of early and very early diagnosis. Clin Orthop Relat Res. 1976; (119):6-10. View

17.

Duppe H, Danielsson L . Screening of neonatal instability and of developmental dislocation of the hip. A survey of 132,601 living newborn infants between 1956 and 1999. J Bone Joint Surg Br. 2002; 84(6):878-85. DOI: 10.1302/0301-620x.84b6.12326. View

18.

Broadhurst C, Rhodes A, Harper P, Perry D, Clarke N, Aarvold A . What is the incidence of late detection of developmental dysplasia of the hip in England?: a 26-year national study of children diagnosed after the age of one. Bone Joint J. 2019; 101-B(3):281-287. DOI: 10.1302/0301-620X.101B3.BJJ-2018-1331.R1. View

19.

Tonnis D . Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res. 1976; (119):39-47. View