Does being male represent a risk factor for DDH treatment? A systematic review

Although female sex is a known risk factor for developmental dysplasia of the hip (DDH), limited data exist regarding sex-specific differences in treatment outcomes. This study aimed to analyze whether being male represents a risk factor for unfavorable outcomes in DDH treatment.

A systematic search was conducted across PubMed, Embase, and Cochrane Library databases to identify studies comparing DDH treatment outcomes between males and females. The review adhered to PRISMA and PROSPERO guidelines, including studies published from 1995 to 2023.

Out of 327 initially identified articles, 23 met the selection criteria, describing 10,307 total DDH cases (5,296 males; 4,700 females). Only six articles clearly reported outcomes stratified by sex. Our analysis focused on establishing whether male sex was a risk factor for Pavlik harness failure and the incidence of avascular necrosis (AVN). For Pavlik harness failure, the meta-analysis included 93 male and 630 female hips, with failure in 32 male (34%) and 148 female (23%) hips. The meta-analysis indicated a significant association between male sex and Pavlik harness failure (P = 0.03). Pooling data from relevant articles for AVN showed that AVN occurred in 32 out of 91 male (35%) and 77 out of 355 female (22%) hips, suggesting a significant association between male sex and AVN (P = 0.008).

Overall, male patients exhibited a higher failure rate in Pavlik harness treatment. The pooled analysis of AVN data further suggests that males may demonstrate a poorer prognosis compared to female patients in DDH treatment.