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Type: Journal article
Title: Evaluation of brace treatment for infant hip dislocation in a prospective cohort defining the success rate and variables associated with failure
Author: Upasani, V.
Bomar, J.
Matheney, T.
Sankar, W.
Mulpuri, K.
Price, C.
Moseley, C.
Kelley, S.
Narayanan, U.
Clarke, N.
Wedge, J.
Castañeda, P.
Kasser, J.
Foster, B.
Herrera-Soto, J.
Cundy, P.
Williams, N.
Mubarak, S.
Citation: Journal of Bone and Joint Surgery: American Volume, 2016; 98(14):1215-1221
Publisher: Lippincott, Williams & Wilkins
Issue Date: 2016
ISSN: 0021-9355
Statement of
Vidyadhar V. Upasani, James D. Bomar, Travis H. Matheney, Wudbhav N. Sankar, Kishore Mulpuri, Charles T. Price, Colin F. Moseley, Simon P. Kelley, Unni Narayanan, Nicholas M.P. Clarke, John H. Wedge, Pablo Castañeda, James R. Kasser, Bruce K. Foster, Jose A. Herrera-Soto, Peter J. Cundy, Nicole Williams, and Scott J. Mubarak
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, chisquare 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.
Keywords: Hip Joint
Rights: Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated
DOI: 10.2106/JBJS.15.01018
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Appears in Collections:Aurora harvest 3
Orthopaedics and Trauma publications

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