BJJ - 2026-06-01 - Journal Article; Multicenter Study
Femoral nerve palsy in brace treatment for developmental dysplasia of the hip : incidence and outcomes in a prospective international cohort.
Schaeffer EK, Wang AWT, Hu J, Nguyen V, Sankar WN, Williams N, Global Hip Dysplasia Study Group, Mulpuri K, Aarvold A, Aroojis A, Bade D, Bavan L, Benaroch T, Castañeda P, Clarke N, Dodwell E, Donnan L, Dulai S, Gardner R, Grigoriou E, Herrera-Soto J, Hopper N, Jaremko J, Kelley S, Kim H, Krishnamoorthy V, Matheney T, Mulpuri K, Patwardhan S, Price C, Pun S, Reidy M, Sahu C, Sankar W, Schaeffer E, Shah H, Smit K, Thacker M, Upasani S, Williams N, Yihua G, Zhang Z
Topics
Key Takeaway
Femoral nerve palsy occurred in 3.1% of children (2.0% of hips) treated with orthosis for DDH, with Pavlik harness use (84.0% vs 61.9%, p<0.001), lower femoral head percent cover, and lower α angle identified as independent risk factors.
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Summary
This multinational prospective study examined risk factors for femoral nerve palsy in children with DDH treated primarily with orthosis. Mixed-effects logistic regression identified Pavlik harness use, lower femoral head percent cover (OR 0.87, 95% CI 0.84–0.91), and lower α angle (OR 0.82, 95% CI 0.76–0.89) as independent predictors of femoral nerve palsy. Palsy developed at a median of 7 days post-brace application, with an overall incidence of 3.1% per child and 2.0% per hip.
Key Limitation
Functional outcomes and resolution rates of femoral nerve palsy episodes are not reported, preventing determination of whether identified risk factors predict transient versus persistent neurologic injury.
Original Abstract
AIMS
Femoral nerve palsy is a potential complication of brace treatment for children with developmental dysplasia of the hip (DDH). Little is known about its causes, and previous studies have been limited by their small sample size, retrospective design, and/or being single-centre series. The aim of this study was to examine the risk factors for femoral nerve palsy in the largest prospective cohort of children to date with DDH treated using an orthosis.
METHODS
A global multicentre prospective database of children with DDH was analyzed. Those treated primarily using an orthosis were included. Mixed-effects logistic regression was used to identify risk factors for the development of femoral nerve palsy, including sex, age at the time of diagnosis and application of an orthosis, the type of orthosis, the location of the femoral head, femoral head cover, and α angle. Both univariate and multivariate analyses were conducted.
RESULTS
The study included 3,008 children (5,012 affected hips) who were enrolled from 21 centres in seven countries; 99 hips (2.0%) in 94 children (3.1%) developed a femoral nerve palsy, which occurred at a median of seven days (IQR 6 to 21) after the application of a brace. A significantly increased proportion of children who developed a femoral nerve palsy were treated in a Pavlik harness compared with those who did not develop a femoral nerve palsy (84.0% (n = 79) vs 61.9% (n = 1,804); p < 0.001). Univariate analyses identified a lower percent cover of the femoral head (odds ratio (OR) 0.87 (95% CI 0.84 to 0.91); p < 0.001) and lower α angle (OR 0.82 (95% CI 0.76 to 0.89); p < 0.001) to be significantly associated with the development of femoral nerve palsy. These risk factors remained significant in the multivariate model.
CONCLUSION
This is the largest multinational study to date evaluating the incidence and risk factors for the development of a femoral nerve palsy in these children. The incidence of femoral nerve palsy was 3.1%. The severity of DDH was identified as a significant risk factor for its development. The use of a Pavlik harness was significantly associated with the development of a femoral nerve palsy. Understanding the factors which influence its development will be important to optimize outcomes of treatment in children with DDH.