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J Bone Joint Surg Am. 2016 Jul 20;98(14):1215-21. doi: 10.2106/JBJS.15.01018.

Evaluation of Brace Treatment for Infant Hip Dislocation in a Prospective Cohort: Defining the Success Rate and Variables Associated with Failure.

Author information

  • 1Rady Children's Hospital, San Diego, California vupasani@rchsd.org.
  • 2Rady Children's Hospital, San Diego, California.
  • 3Boston Children's Hospital, Boston, Massachusetts.
  • 4Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
  • 5British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
  • 6Arnold Palmer Hospital for Children, Orlando, Florida.
  • 7Hilton Head Island, South Carolina.
  • 8Hospital for Sick Children, Toronto, Ontario, Canada.
  • 9University of Southampton, Southampton, Hampshire, United Kingdom.
  • 10Centro Médico ABC Santa Fe, Mexico City, Tlaxcala, Mexico.
  • 11Department of Orthopaedic Surgery, Women's and Children's Hospital, North Adelaide, South Australia, Australia.

Abstract

BACKGROUND:

The use of a brace has been shown to be an effective treatment for hip dislocation in infants; however, previous studies of such treatment have been single-center or retrospective. The purpose of the current study was to evaluate the success rate for brace use in the treatment of infant hip dislocation in an international, multicenter, prospective cohort, and to identify the variables associated with brace failure.

METHODS:

All dislocations were verified with use of ultrasound or radiography prior to the initiation of treatment, and patients were followed prospectively for a minimum of 18 months. Successful treatment was defined as the use of a brace that resulted in a clinically and radiographically reduced hip, without surgical intervention. The Mann-Whitney test, chi-square analysis, and Fisher exact test were used to identify risk factors for brace failure. A multivariate logistic regression model was used to determine the probability of brace failure according to the risk factors identified.

RESULTS:

Brace treatment was successful in 162 (79%) of the 204 dislocated hips in this series. Six variables were found to be significant risk factors for failure: developing femoral nerve palsy during brace treatment (p = 0.001), treatment with a static brace (p < 0.001), an initially irreducible hip (p < 0.001), treatment initiated after the age of 7 weeks (p = 0.005), a right hip dislocation (p = 0.006), and a Graf-IV hip (p = 0.02). Hips with no risk factors had a 3% probability of failure, whereas hips with 4 or 5 risk factors had a 100% probability of failure.

CONCLUSIONS:

These data provide valuable information for patient families and their providers regarding the important variables that influence successful brace treatment for dislocated hips in infants.

LEVEL OF EVIDENCE:

Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:
27440570
DOI:
10.2106/JBJS.15.01018
[PubMed - in process]
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