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Late-Presenting Developmental Dysplasia of the Hip Treated with the Modified Hoffmann-Daimler Functional Method
Nikolaos G. Papadimitriou, MD, PhD1; Aggeliki Papadimitriou, MD2; John E. Christophorides, MD, PhD2; Theodoros A. Beslikas, MD, PhD2; Perikles K. Panagopoulos, MD2
1 Mantzaridi 3 N 751 Panorama, 55236 Thessaloniki, Greece. E-mail address: papadig@hotmail.com
2 2nd Orthopaedic Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Ethnikis Aminis 41 Str, 54635 Thessaloniki, Greece
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Aristotle University of Thessaloniki, 2nd Orthopaedic Department, G. Gennimatas Hospital, Thessaloniki, Greece

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Jun 01;89(6):1258-1268. doi: 10.2106/JBJS.E.01414
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Background: The general consensus is that nonoperative treatment of developmental dysplasia of the hip should not be attempted for patients in whom previous treatment of the disease has failed, those in whom the disease was neglected, or those in whom the disease presented late. In such cases, it is believed that the optimum period for hip remodeling has passed and that operative methods are preferable. The purpose of the present study was to report the efficacy of a modified form of the Hoffmann-Daimler method for the treatment of late-presenting developmental dysplasia of the hip.

Materials: We retrospectively reviewed the records of sixty-nine patients (ninety-five hips) with neglected developmental dysplasia of the hip who had been managed nonoperatively with a modification of the Hoffmann-Daimler method from 1971 to 2000. With this method, the patient wears a flexion harness (Phase A), during which time the femoral head is gradually reduced, followed by an abduction splint (Phase B), during which time the reduced hip remodels. We have modified the original method by introducing new treatment strategies. The study group included nine boys and sixty girls. The average age of the patients was sixteen months (range, six to forty-four months) at the start of treatment and 11.5 years (range, six to twenty-nine years) at the time of the latest follow-up. Radiographs were assessed to determine the acetabular index, the Severin classification, and the presence of evidence of osteonecrosis of the proximal femoral epiphysis. Hips that were rated as Severin class I or class II were classified as satisfactory, whereas those that were rated as Severin class III or class IV were classified as unsatisfactory.

Results: On the basis of the most recent follow-up radiographs, eighty-eight (93%) of the dislocated hips were classified as satisfactory (sixty-seven were rated as Severin class I and twenty-one were rated as Severin class II) and seven were classified as unsatisfactory (six were rated as Severin class III and one was rated as Severin class IV). No hip was rated as Severin class V or VI. The average acetabular index was 40° ± 7.4° prior to the onset of treatment and 24° ± 5.7° at the end of treatment. No redislocations or other complications were noted. Osteonecrosis was noted in six of the ninety-five hips.

Conclusions: Late-presenting or neglected developmental dysplasia of the hip can be successfully treated with use of a modified Hoffmann-Daimler method. The high rate of successful reduction, the low prevalence of osteonecrosis and residual dysplasia, and the limited complications may make this modified method a safe alternative to surgical treatment.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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