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Outcome after early mobilization following hip reconstruction in children with developmental hip dysplasia and
Katharina Susanne Gather1, Eva von Stillfried2, Sebastien Hagmann2
1Center of Orthopaedic and Trauma Surgery/Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany. Katharina.Gather@med.uni-heidelberg.de.
Insights
Early mobilization after hip reconstruction in children with developmental hip dysplasia (DDH) offers a safe alternative to spica casting. This approach shows successful clinical and radiographic outcomes without complications, improving patient recovery.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
Background:
- Spica cast immobilization is standard post-hip reconstruction for developmental hip dysplasia (DDH) in children, typically lasting 4-12 weeks.
- This traditional method presents challenges and potential complications.
- Limited research exists on early mobilization without casting for postoperative care in DDH hip reconstruction.
Purpose of the Study:
- To evaluate the efficacy and safety of early mobilization without cast therapy after hip reconstruction in pediatric DDH patients.
- To compare clinical and radiographic outcomes with traditional spica casting methods.
Main Methods:
- Retrospective study of 27 children (33 hips) with DDH (Tönnis grade 1-4) undergoing hip reconstruction.
- Postoperative care involved a foam shell brace with specific hip positioning (30° abduction, extension, neutral rotation).
- Early mobilization physiotherapy initiated within days, with full weight-bearing at 3-4 weeks; clinical and radiographic assessments were performed pre- and post-surgery.
Main Results:
- Significant improvement in hip parameters: acetabular index decreased from 36.9° to 21.7°, and center-edge angle increased from 9.9° to 28.6°.
- All hips achieved Tönnis grade 1 at final follow-up (12.3 months).
- No major complications were reported, including dislocation, avascular necrosis, non-union, or nerve injury.
Conclusions:
- Early mobilization without cast therapy is a successful treatment option for hip reconstruction in DDH.
- This approach demonstrates favorable clinical and radiographic outcomes and a low complication rate.
- Suggests early mobilization as a viable alternative to spica casting for pediatric DDH hip reconstruction.
Background:
Most orthopedic surgeons prefer spica cast immobilization in children for 4 to 12 weeks after surgical hip reconstruction in children with developmental hip dysplasia. This challenging treatment may be associated with complications. Studies are lacking that focus on early mobilization without casting for postoperative care after hip reconstruction.
Methods:
Twenty-seven children (3.4±2.0 years), including 33 hips with developmental hip dysplasia (DDH) and dislocation of the hip (Tönnis grade 1 to 4), who underwent hip reconstruction (Dega acetabuloplasty, varisation-derotation osteotomy and facultative open reduction) were retrospectively included in this study. Postoperatively the patients were placed in an individual foam shell with 30 degrees of hip abduction, hip extension, and neutral rotation. Early mobilization physiotherapy was performed within the first few days after the surgery under epidural anaesthesia. Full weight bearing was allowed after 3-4 weeks. All children received a clinical examination and radiographic evaluation before and after surgical intervention. The follow-up period was 12.3±2.9 months.
Results:
On average, the postoperative acetabular index decreased significantly from 36.9 to 21.7 degrees and the center-edge angle increased from 9.9 to 28.6 degrees. All hips had reached Tönnis grade 1 at the time of the last follow-up. No complications such as dislocation of the bone wedge, avascular necrosis of the acetabulum or femur, lack of non-union, or nerve injury, were reported.
Conclusions:
In this cohort study, hip reconstruction was successful according to clinical and radiographic outcome parameters after early mobilization without cast therapy. Early mobilization may be used as an alternative treatment option after hip reconstruction in DDH.
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