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NOTE TO EDITORS: Dr. Stuart L. Weinstein was named president of the American Orthopaedic Association at its annual meeting June 11-14 in Boca Raton, Fla. The association is the oldest national orthopaedic organization in the world.

UI researcher questions traction to treat developmental dislocation of hip

IOWA CITY, Iowa -- For decades, traction has been used routinely to treat dislocated hips in children. But as a University of Iowa College Medicine researcher points out, little scientific evidence exists to show this procedure makes any difference in treating newborn and young children with hip problems.

In an article published in the May issue of Clinical Orthopaedics and Related Research, Dr. Stuart L. Weinstein, UI professor of orthopaedic surgery, says that although there are reports on the positive effects of traction in developmental dislocation of the hip, no clinical or experimental studies have been done looking specifically at the effect of traction on this condition. Thus, Weinstein argues, there is no scientific proof that traction affects the outcome of treatments for children with a dislocated hip.

"Basically, it's a widely used treatment that's not based on good scientific literature," Weinstein says. "Perhaps we should be using traction to treat developmental dislocation of the hip. I'm arguing that the scientific literature is not solid enough to back that up."

Unstable hips in children occur in about one in 100 newborns, while actual dislocation of the hip is about one in 1,000. If not treated, the condition can lead to degenerative joint disease and disability.

Using traction before putting the hip back into its socket, whether by surgery or by manipulation (known as open or closed reduction), has been a standard procedure in the United States for years. The thought is that traction makes it easier to perform the reduction and lessens the risk of complications, such as damage to the blood supply to the femoral head, the ball-shaped end of the femur, which is the long leg bone that runs from the hip to the knee.

However, as Weinstein notes in the article, many variables -- such as traction methods, direction and duration -- have not been given sufficient scientific study to determine whether or not traction plays a factor in treating dislocation of the hip in children. "In other words, there are scientifically-proven factors that can make the outcome worse, but there's no evidence that traction affects any of these factors," he says.

Whether traction can be applied in the home or should be administered in a hospital setting is another area of disagreement among orthopaedic surgeons in North America and Europe. "Traction for this type of treatment typically is used for 10 days to three weeks in a hospital, which can be very expensive," Weinstein says. "But the standards of medical literature today are different than the standards of medical literature in the past, when studies touting the benefits of traction were conducted."

Weinstein reports that as many as 95 percent of all orthopaedic surgeons in North America use traction in their practices. "The key to medical treatment, whatever the treatment, is that it should alter the outcome in a positive way. Currently we have no scientific proof that traction does that in these situations," he says.