The efficacy of Tübingen splint in developmental dysplasia of the hip in children under 6 months: A systematic review and meta-analysis

Abstract

Background: Bracing is considered the most effective treatment for developmental dysplasia of the hip (DDH) in infants aged < 6 months with reducible hips. The Tübingen splint was developed as an advancement in abduction brace for managing hip dysplasia, in stable and unstable hip cases. In this systematic review and meta-analysis, the outcomes of the Tübingen splint in treating patients with DDH aged < 6 months were evaluated. The outcomes were categorized according to the Graf classification (IIa, IIb, IIc, IId, III, and IV), based on success and complication rates.

Methods: The systematic review and meta-analysis were conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines. A systematic search was conducted using Scopus, Embase, PubMed, Cochrane Library, and Google Scholar from inception to March 2024. The primary outcomes were the success rate for each Graf type, and the secondary outcome involved evaluating the complication rate through conditional subgroup analysis.

Results: Nine observational studies involving 1456 hip cases were analyzed. Tübingen splint resulted in an overall success rate of 86% (95% confidence interval [CI] [0.80-0.92]; P < .01; χ² = 87%), with 97% (95% CI [0.94-1.00]; P < .01; χ² = 66%) for Graf type II DDH, 94% (95% CI [0.91-0.97]; P = .41; χ² = 2%) for Graf type III DDH, and 48% (95% CI [0.26-0.71]; P < .01; χ² = 86%) for Graf type IV DDH. The overall complication rate was 2% (95% CI [0.00-0.03]; P < .01; χ² = 65%), including 1% (95% CI [0.00-0.01]; P = .47; χ² = 0%) of avascular necrosis and 6% (95% CI [0.03-0.08]; P = .69; χ² = 0%) of residual acetabular dysplasia.

Conclusion: These findings support the use of the Tübingen splint as a highly effective first-line conservative treatment option for DDH in infants under 6 months of age, demonstrating notable efficacy, particularly for Graf types II and III cases.

Level of evidence: III.

Keywords: Graf classification; Pavlik harness; Tübingen splint; avascular necrosis; bracing; developmental dysplasia of the hip; femoral nerve palsy; residual acetabular dysplasia.