What is the treatment for hip dysplasia?

Treatment of Developmental Dysplasia of the Hip

The primary treatment for developmental dysplasia of the hip (DDH) in infants up to 6 months of age is the Pavlik harness, which has a success rate of 67-83% when applied early, particularly before 6 weeks of age. 1

Age-Based Treatment Algorithm

Infants Under 6 Months

1. Initial Diagnosis

   • 0-4 weeks: Clinical examination only; imaging not recommended for initial screening 1
   • 4 weeks-4 months: Ultrasound of the hips for suspected DDH 1
   • 4-6 months: Radiograph of the pelvis becomes the preferred imaging modality 1

2. Treatment Approach

   • Mild instability: Many cases (60-80% identified on physical exam, >90% on ultrasound) resolve spontaneously 1
   • Confirmed DDH: Pavlik harness as first-line treatment 1, 2
     • Most effective when applied before 6 weeks of age
     • Can be used up to 6 months of age
     • Treatment duration typically 6-12 weeks

3. Monitoring During Treatment

   • Serial physical examinations
   • Ultrasound for children <6 months to confirm concentric reduction 1
   • Radiographs near conclusion of treatment to document acetabular development 1

Older Infants and Children (>6 months)

• Pavlik harness less effective; surgical intervention may be required
• Options include:
  • Closed reduction and spica casting
  • Open reduction if closed reduction fails
  • Pelvic or femoral osteotomies for residual acetabular dysplasia 3

Effectiveness of Treatment

The Pavlik harness shows excellent results in properly selected cases:

• 95.4% success rate reported in severe DDH when properly managed 2
• Long-term studies show very low rates (2.81%) of residual dysplasia after 20+ years of follow-up 4
• 90% of dislocated hips can be successfully reduced with proper harness use 2

Important Considerations and Pitfalls

1. Proper Harness Selection and Application

   • Limited evidence supports von Rosen splint over Pavlik, Craig, or Frejka splints 1
   • Poor quality harness construction can contribute to treatment failure 5

2. Monitoring Requirements

   • Regular clinical examinations out of the harness
   • Failure to achieve reduction must be recognized promptly 5
   • Ultrasound monitoring during treatment to confirm reduction 1

3. Complications to Watch For

   • Avascular necrosis (1-30% of cases) 3, 5
   • Risk factors for avascular necrosis include:
     • Excessive hip abduction
     • Forceful closed reduction
     • Maintaining a dislocated hip in the harness 3
   • Femoral nerve palsy (rare)

4. Treatment Failure Factors

   • Severity of initial hip dysplasia (Graf type IV or highly dislocated hips) 6
   • Treatment initiation after 3 months of age 6
   • Poor parent compliance with harness use 5
   • Improper harness application by physician 5

Special Situations

• Graf Type IIc or Worse: Requires immediate treatment, with Pavlik harness as first-line approach 2, 4
• Ortolani-Positive Hip: Requires immediate treatment 3
• Stable Hip with Ultrasound Abnormalities: Limited evidence supports observation without bracing 1

By following this structured approach to DDH treatment with careful attention to age-appropriate interventions and proper monitoring, most cases can be successfully managed with excellent long-term outcomes and minimal complications.