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

Treatment of Developmental Dysplasia of the Hip (DDH)

The treatment of DDH primarily involves the Pavlik harness for infants up to 6 months of age, with surgical intervention reserved for severe cases, late presentation, or failed nonoperative management. 1

Age-Based Treatment Approach

Infants Under 6 Months

1. First-line treatment: Pavlik harness

   • Most effective when applied before 6 weeks of age
   • Can be used up to 6 months of age
   • Success rate ranges from 67-83% 1
   • Typical treatment duration: 6-12 weeks 2

2. Monitoring during harness treatment:

   • Ultrasound to confirm concentric hip reduction 1
   • Serial physical examinations throughout treatment 1
   • Predictors of treatment failure: low postreduction alpha angle and <20% femoral head coverage 1

3. Alternative bracing options:

   • Limited evidence suggests the von Rosen splint may be superior to Pavlik, Craig, or Frejka splints 1, 3
   • A 2021 systematic review showed the von Rosen splint had better success rates and less residual dysplasia compared to other devices 3

4. For stable hips with ultrasound abnormalities:

   • Observation without bracing may be appropriate 1, 2
   • Many mild cases resolve spontaneously (60-80% of cases identified on physical exam and >90% on ultrasound) 2

Infants 6-18 Months

• Failed Pavlik harness treatment:
  • Closed reduction under anesthesia followed by spica casting 4
  • Waterproof casting materials can help maintain hygiene during the typical 3-month treatment period 4
  • Confirmation of reduction via arthrogram or advanced imaging such as 3D CT 4

Children Over 18 Months

• Surgical intervention:
  • Open reduction and hip reconstruction surgery 5
  • Required for severe dysplasia, dislocation, late presentation/diagnosis, or failed nonoperative management 1

Monitoring and Follow-up

1. During treatment:

   • For children <6 months: Ultrasound monitoring to confirm reduction 1, 2
   • Radiographs near conclusion of treatment to document acetabular development 1

2. Long-term follow-up:

   • Regular radiographic assessment to monitor for residual dysplasia
   • A comprehensive protocol with structured follow-up can reduce residual dysplasia rates to as low as 1.6% at 5-year follow-up 6

Potential Complications

• Avascular necrosis of the femoral head: Most serious complication of treatment 1
• Femoral nerve palsy: Reported in approximately 1% of cases 6
• Residual dysplasia: May require surgical intervention if persistent 6
• Skin problems: Can occur with prolonged bracing 1

Treatment Algorithm

1. Diagnosis confirmation:

   • 0-4 weeks: Clinical examination only
   • 4 weeks-4 months: Ultrasound of the hips
   • 4-6 months: Radiograph of the pelvis 2

2. Treatment initiation:

   • If diagnosed <6 months: Begin with Pavlik harness
   • If diagnosed 6-18 months: Consider closed reduction and spica casting
   • If diagnosed >18 months: Surgical intervention likely needed 5

3. Treatment monitoring:

   • Regular clinical examinations
   • Ultrasound for children <6 months to confirm reduction
   • Radiographs at treatment conclusion 1, 2

Early diagnosis and treatment are critical for optimal outcomes, as persistent hip dysplasia into adolescence and adulthood may result in abnormal gait, decreased strength, and increased rates of degenerative joint disease 5.