When Pavlik introduced his method of treating congenital dislocation of the hip, he emphasized reducing the rate of osteonecrosis.
Graf’s method of sonographic evaluation afforded earlier accurate diagnosis and subsequent treatment of developmental dysplasia
of the hip. To ascertain whether treatment duration, gender, age at diagnosis, clinical stability, and/or treatment onset
correlate with the risk of osteonecrosis in Graf Type III or IV hips, we clinically and sonographically screened 18,067 neonates
(36,134 hips) for developmental dysplasia of the hip over a 4-year period; 151 had Graf Type III or IV hips, and 78 of these
were treated by us and had known outcomes. Of these 78 hips, 65 (0.18%) had Graf Type III and 13 (0.036%) had Graf Type IV
hips. Sixteen of the 65 Type III hips (25%) reduced spontaneously. Using Pavlik’s method, reduction was achieved in 46 of
65 (88.5%) Type III hips and eight of 13 Type IV hips. None of the hips treated exclusively by Pavlik’s method developed osteonecrosis.
Thus, the method achieves one of Pavlik’s original goals of decreasing osteonecrosis incidence to close to zero.
Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his institution has waived or does not require approval for the human protocol for this investigation
and that all investigations were conducted in conformity with ethical principles of research.