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Three-year prospective study of developmental dysplasia of the hip at birth: should all dislocated or dislocatable
Francisco J Lorente Moltó1, Antonio Mascarell Gregori, Luis Miranda Casas
1Department of Pediatric Surgery, Section of Orthopedic Surgery, La Fe Hospital for Children, Valencia, Spain. lorente_fra@gva.es
Insights
Most infants with developmental dysplasia of the hip (DDH) do not require immediate treatment. Delayed intervention for persistent DDH shows comparable outcomes to early treatment, reducing healthcare costs.
Area of Science:
- Orthopedics
- Pediatric Medicine
- Radiology
Background:
- Developmental dysplasia of the hip (DDH) is a common condition in newborns.
- Early intervention is often standard practice for DDH.
- The necessity of immediate treatment for all DDH cases is debated.
Purpose of the Study:
- To evaluate the outcomes of a delayed treatment protocol for infants diagnosed with DDH at birth.
- To determine if delaying treatment affects long-term hip stability and development.
- To assess the impact of a selective, delayed treatment approach on healthcare resource utilization.
Main Methods:
- A 3-year prospective study of 103 infants with congenital DDH.
- Treatment initiated after 2 weeks only if hips did not stabilize spontaneously.
- Sonographic studies used to confirm concentric hip reduction post-stabilization.
- Comparison with a control group of 50 infants treated in the first days of life.
Main Results:
- 73.8% of infants with DDH at birth achieved spontaneous hip stability and required no treatment.
- Infants requiring splinting after 2 weeks (26.2%) showed no significant differences compared to the early-treated control group.
- The selective delayed treatment approach reduced the number of interventions and sonographic studies.
Conclusions:
- Most cases of DDH at birth resolve spontaneously without intervention.
- Delayed treatment for persistent DDH is a safe and effective alternative to immediate treatment.
- This approach can significantly reduce healthcare costs associated with DDH management.
Abstract:
This article presents a 3-year prospective study that includes 103 consecutive patients (137 hips) diagnosed with developmental dysplasia of the hip (DDH) at birth. Treatment was started after 2 weeks only if the hips had not stabilized spontaneously. Sonographic studies were first used when clinical stability was confirmed to ensure a true concentric hip reduction. The authors conclude that most patients with DDH at birth (73.8%) do not need treatment at that time, presenting with normal hips at the end of follow-up. When instability was still present after 2 weeks and a splint was applied (26.2%), there were no significant hip differences when compared with a control group of 50 patients (69 hips) who underwent treatment in the first days of life. With this approach, the authors could safely reduce the number of patients to be treated, the amount of sonographic studies, and consequently the final cost of the whole treatment.
