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
Keywords:Abduction splint, DDH, Hip, Hip dysplasia, NIH, Paediatric orthopaedics, von Rosen
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.
Düppe H, Danielsson L G. 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. DOI: https://doi.org/10.1302/0301-620X.84B6.0840878
von Rosen S. Early diagnosis and treatment of congenital dislocation of the hip joint. Acta Orthop Scand 1956; 26(2): 136-55. DOI: https://doi.org/10.1080/00016470.1956.11978730
Ortolani M. Congenital hip dysplasia in the light of early and very early diagnosis. Clin Orthop Relat Res 1976; (119): 6-10. DOI: https://doi.org/10.1097/00003086-197609000-00003
Barlow T G. Congenital dislocation of the hip in the newborn. Proc R Soc Med 1966; 59(11 Part 1): 1103-6. DOI: https://doi.org/10.1177/003591576605911P118
Lauge-Pedersen H, Gustafsson J, Hägglund 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. DOI: https://doi.org/10.1080/17453670610045993
Dahlström H, Oberg L, Friberg S. Sonography in congenital dislocation of the hip. Acta Orthop Scand 1986; 57(5): 402-6. doi: 10.3109/17453678609014757. DOI: https://doi.org/10.3109/17453678609014757
Tönnis 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. DOI: https://doi.org/10.1097/00003086-197609000-00007
Wenger D, Düppe H, Tiderius C J. Acetabular dysplasia at the age of 1 year in children with neonatal instability of the hip. Acta Orthop 2013; 84(5): 483-8. doi: 10.3109/17453674.2013.850009. DOI: https://doi.org/10.3109/17453674.2013.850009
Kalamchi A, MacEwen G D. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980; 62(6): 876-88. DOI: https://doi.org/10.2106/00004623-198062060-00002
Hahn S. Understanding noninferiority trials. Korean J Pediatr 2012; 55(11): 403-7. doi: 10.3345/kjp.2012.55.11.403. DOI: https://doi.org/10.3345/kjp.2012.55.11.403
Wilkinson A G, Sherlock D A, Murray G D. 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. DOI: https://doi.org/10.1302/0301-620X.84B5.0840716
Wenger D, Samuelsson H, Düppe H, Tiderius C J. 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. doi: 10.3109/17453674.2015.1126158. DOI: https://doi.org/10.3109/17453674.2015.1126158
Sahlstrand T, Malmgren N, Ahlgren S A, 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. DOI: https://doi.org/10.1097/01241398-198509000-00006
Wenger D, Düppe H, Nilsson J-Å, Tiderius C J. Incidence of late-diagnosed hip dislocation after universal clinical screening in Sweden. JAMA Network Open 2019; 2(11): e1914779-e1914779. doi: 10.1001/jamanetworkopen.2019.14779. DOI: https://doi.org/10.1001/jamanetworkopen.2019.14779
Barlow T G. Early diagnosis and treatment of congenital dislocation of the hip. J Bone Joint Surg Br 1962; 44-B(2): 292-301. DOI: https://doi.org/10.1302/0301-620X.44B2.292
Albinana J, Dolan L A, Spratt K F, Morcuende J, Meyer M D, Weinstein S L. 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 DOI: https://doi.org/10.1302/0301-620X.86B6.14441
von Kries R, Ihme N, Oberle D, Lorani A, Stark R, Altenhofen L, et al. Effect of ultrasound screening on the rate of first operative procedures for developmental hip dysplasia in Germany. Lancet 2003; 362(9399): 1883-7. DOI: https://doi.org/10.1016/S0140-6736(03)14957-4
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. DOI: https://doi.org/10.1007/s11832-014-0555-6
Broadhurst C, Rhodes A M L, Harper P, Perry D C, Clarke N M P, 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): 281-7. DOI: https://doi.org/10.1302/0301-620X.101B3.BJJ-2018-1331.R1
Boniforti F G, Fujii G, Angliss R D, Benson M K. The reliability of measurements of pelvic radiographs in infants. J Bone Joint Surg Br 1997; 79(4): 570-5. DOI: https://doi.org/10.1302/0301-620X.79B4.0790570
How to Cite
Copyright (c) 2023 Adam Sand, Carl Johan Tiderius, Henrik Düppe, Daniel Wenger
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.