Effectiveness of closed treatment for late-presentation developmental dysplasia of the hip

Abstract

Background: Developmental dysplasia of the hip (DDH) is the most common developmental musculoskeletal disorder. Late presentation of DDH is defined by a diagnosis made when a child is older than 3 months. Few studies evaluate the effectiveness of conservative management with bracing in this cohort.

Aims: This study aimed to evaluate the effectiveness of nonoperative treatment, using the Pavlik harness and Boston brace, in patients presenting with developmental dysplasia of the hip (DDH) who commenced treatment following initial ultrasound scans done between 91 and 182 days (3 to 6 months). The secondary objective was to identify potential risk factors associated with treatment failure.

Methods: We conducted a retrospective review of 54 such cases treated at our institution over a 7-year period. Various factors, including age at treatment initiation, gender, Graf classification and duration of treatment, were analysed.

Results: Closed treatment was successful in 44 patients. Five remain under review. Four patients required closed reduction and subsequently progressed to pelvic osteotomy for residual dysplasia. One further patient had a pelvic osteotomy for residual dysplasia. The four patients who required closed reduction had all had Type III hips. Gender and age of commencement of treatment did not predict outcome.

Conclusions: Our findings suggest that closed treatment with a Pavlik harness and/or Boston brace can still be an effective treatment strategy for late-presenting DDH. We found that treatment failure is more likely in more severely dysplastic hips.

Keywords: Boston bracing; Conservative treatment; Developmental dysplasia of the hip (DDH); Graf method; Late presentation; Pavlik harness; Treatment outcomes.