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A comprehensive nonoperative treatment protocol for developmental dysplasia of the hip in infants : a prospective
Catharine S Bradley1, Yashvi Verma1, Connor L Maddock1
1Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada.
Insights
A comprehensive nonoperative brace protocol for infant hip dysplasia (DDH) shows high success rates. This evidence-based approach significantly reduces residual dysplasia, offering a promising treatment for DDH.
Area of Science:
- Orthopedics
- Pediatric Medicine
- Radiology
Background:
- Developmental dysplasia of the hip (DDH) management lacks standardized evidence-based protocols, leading to practice variations.
- Brace treatment is a primary nonoperative approach for DDH.
Purpose of the Study:
- To develop and evaluate a comprehensive, evidence-based nonoperative brace treatment protocol for infant DDH.
- To establish clear inclusion and success criteria for DDH brace management.
Main Methods:
- A prospective, longitudinal cohort study of infants with ultrasound-confirmed DDH.
- Implementation of a unified, multidisciplinary clinic protocol for nonoperative brace management.
- Radiological assessment at five-year follow-up using standardized metrics (AI-L, AI-S, CEA, ADR, IHDI grade, AVN).
Main Results:
- 95% of infants successfully completed the bracing protocol; 5% failed due to irreducible hips.
- High success rates for unilateral (88%) and bilateral (83%) dislocations.
- Low prevalence of residual dysplasia (1.6%) and no cases of avascular necrosis (AVN) at five years.
Conclusions:
- The developed comprehensive nonoperative protocol for infant DDH demonstrates high success rates.
- This protocol leads to extremely low rates of residual dysplasia at a mean five-year follow-up.
- The findings support the protocol's efficacy in managing infant DDH.
Aims:
Brace treatment is the cornerstone of managing developmental dysplasia of the hip (DDH), yet there is a lack of evidence-based treatment protocols, which results in wide variations in practice. To resolve this, we have developed a comprehensive nonoperative treatment protocol conforming to published consensus principles, with well-defined a priori criteria for inclusion and successful treatment.
Methods:
This was a single-centre, prospective, longitudinal cohort study of a consecutive series of infants with ultrasound-confirmed DDH who underwent a comprehensive nonoperative brace management protocol in a unified multidisciplinary clinic between January 2012 and December 2016 with five-year follow-up radiographs. The radiological outcomes were acetabular index-lateral edge (AI-L), acetabular index-sourcil (AI-S), centre-edge angle (CEA), acetabular depth ratio (ADR), International Hip Dysplasia Institute (IHDI) grade, and evidence of avascular necrosis (AVN). At five years, each hip was classified as normal (< 1 SD), borderline dysplastic (1 to 2 SDs), or dysplastic (> 2 SDs) based on validated radiological norm-referenced values.
Results:
Of 993 infants assessed clinically and sonographically, 21% (212 infants, 354 abnormal hips) had DDH and were included. Of these, 95% (202 infants, 335 hips) successfully completed bracing, and 5% (ten infants, 19 hips) failed bracing due to irreducible hip(s). The success rate of bracing for unilateral dislocations was 88% (45/51 infants) and for bilateral dislocations 83% (20/24 infants). The femoral nerve palsy rate was 1% (2/212 infants). At five-year follow-up (mean 63 months (SD 5.9; 49 to 83)) the prevalence of residual dysplasia after successful brace treatment was 1.6% (5/312 hips). All hips were IHDI grade I and none had AVN. Four children (4/186; 2%) subsequently underwent surgery for residual dysplasia.
Conclusion:
Our comprehensive protocol for nonoperative treatment of infant DDH has shown high rates of success and extremely low rates of residual dysplasia at a mean age of five years.
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