What is the treatment algorithm for Developmental Dysplasia of the Hip (DDH)?

From the Guidelines

The treatment algorithm for Developmental Dysplasia of the Hip (DDH) should prioritize early intervention with a Pavlik harness for infants younger than 6 months, as it has the highest success rate when applied before 6 weeks of age 1. The treatment approach for DDH varies based on the age of the child and the severity of the condition.

• For infants younger than 6 months, treatment typically begins with a Pavlik harness worn 23 hours daily for 6-12 weeks to maintain the hip in a flexed and abducted position, allowing the femoral head to deepen the acetabulum naturally.
• Weekly clinical and ultrasound monitoring is recommended during this period, as the efficacy of the Pavlik harness decreases with age 1.
• If the Pavlik harness fails or if the child is diagnosed between 6-18 months of age, closed reduction under anesthesia followed by spica casting for 3-4 months is the standard approach.
• The spica cast maintains the hip in a reduced position (approximately 100° flexion and 45° abduction).
• For children older than 18 months, treatment often requires open reduction with possible femoral or pelvic osteotomy to correct bony deformities, followed by spica casting for 6-12 weeks.
• Post-treatment, all patients require regular follow-up with radiographs until skeletal maturity to monitor for complications such as avascular necrosis or residual dysplasia, as early intervention is crucial to prevent premature osteoarthritis, gait abnormalities, and chronic pain in adulthood 1. It is essential to note that the overall success rate of the Pavlik harness ranges from 67% to 83%, and surgical intervention is typically reserved for children with severe dysplasia or dislocation, late presentation or diagnosis, or failed nonoperative management 1.

From the Research

Treatment Algorithm for Developmental Dysplasia of the Hip (DDH)

The treatment algorithm for DDH involves several steps and considerations, including the age of the patient and the severity of the condition.

• For infants under 6 months, the Pavlik harness is a common treatment option 2, 3.
• If the Pavlik harness is not successful, closed reduction and spica casting may be used 3.
• For children over 18 months, open reduction and hip reconstruction surgery are often necessary 3.
• The treatment protocol may vary depending on the severity of the DDH and the presence of any complications, such as avascular necrosis 2, 4.

Imaging and Diagnosis

Imaging modalities, such as ultrasonography and radiography, play a crucial role in diagnosing and monitoring DDH 5, 6.

• For infants under 4 months, screening hip ultrasound is recommended for those with risk factors or equivocal exam findings 5.
• For infants over 4-6 months, pelvis radiography is preferred 5.
• Magnetic resonance imaging (MRI) may be used to confirm concentric hip joint reduction and identify any postoperative complications 5.

Follow-up and Outcomes

The follow-up period for DDH treatment can vary, but a study suggests that a longer follow-up may not be necessary for patients with a normal X-ray at 2 years of age 4.

• A retrospective review of 109 hips in 83 children found that all had a normal clinical examination and X-ray at a mean follow-up of 10 years and 2 months 4.
• However, the lack of a standardized treatment protocol and varying practices among pediatric orthopaedic surgeons highlight the need for further research and guidelines 6.