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Review
. 2025 Feb 19:64:102944.
doi: 10.1016/j.jcot.2025.102944. eCollection 2025 May.

Impact of age and timing of hip orthosis on treatment outcomes in infants with developmental dysplasia of the hip: A systematic review and meta-analysis

Daniela Alessia Marletta  1 , Biagio Zampogna  1   2   3 , Gabriele Giuca  1 , Matteo Nanni  1 , Sanzarello Ilaria  1 , Danilo Leonetti  1
Affiliations
Review

Impact of age and timing of hip orthosis on treatment outcomes in infants with developmental dysplasia of the hip: A systematic review and meta-analysis

Daniela Alessia Marletta et al. J Clin Orthop Trauma. .

Abstract

Background: Developmental Dysplasia of the Hip (DDH) is a prevalent pediatric condition affecting 1-3% of newborns worldwide. Early treatment is crucial to prevent long-term complications such as residual dysplasia, avascular necrosis (AVN), and osteoarthritis. Despite the widespread use of the Pavlik harness, the optimal timing of hip orthosis initiation remains a topic of debate. This systematic review and meta-analysis evaluate the impact of age and timing of hip orthosis application on treatment outcomes in infants with DDH.

Methods: This systematic review was registered on PROSPERO (Registration No. CRD42025638433). A comprehensive literature search was conducted in PubMed, Scopus, and Cochrane Library for studies published between 2000 and 2024. Twenty-two studies meeting inclusion criteria were analyzed, focusing on success rates, healing times, and complications such as AVN and residual dysplasia. Data were pooled for meta-analysis, and statistical analyses were performed using a random-effects model to assess the impact of treatment timing.

Results: Infants treated before 3 months of age achieved a pooled success rate of 88.79 % (SE: 0.57 %), with lower complication rates, including AVN (0.89 %, SE: 0.18 %) and residual dysplasia (1.80 %, SE: 0.25 %). In contrast, treatment initiation between 3 and 6 months had a slightly lower success rate of 87.78 % (SE: 0.34 %), but with higher AVN (9.66 %, SE: 0.30 %) and residual dysplasia (20.27 %, SE: 0.40 %) rates. The Pavlik harness and Tübingen hip flexion splint were most effective in early-treated cases, whereas later treatment initiation or severe presentations resulted in less favorable outcomes.

Conclusion: Early treatment initiation, particularly before 3 months of age, significantly improves treatment success and reduces long-term complications. These findings emphasize the necessity of early screening and timely intervention to optimize outcomes. Future research should focus on refining treatment protocols for delayed presentations and improving management strategies for severe dysplasia.

Level of evidence: Level IV.

Keywords: DDH; Developmental dysplasia of the hip; Hip orthosis; Pavlik harness; Treatment timing.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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References

    1. Vaquero-Picado A., González-Morán G., Garay E.G., Moraleda L. Developmental dysplasia of the hip: update of management. EFORT Open Rev. 2019;4(9):548–556. doi: 10.1302/2058-5241.4.180019. - DOI - PMC - PubMed
    1. Weinstein S.L., Holt J.B. The Pediatric and Adolescent Hip. Springer International Publishing; 2019. Developmental dysplasia of the hip in young children; pp. 75–129. - DOI
    1. Senaran H., Bowen J.R., Harcke H.T. Avascular necrosis rate in early reduction after failed Pavlik harness treatment of developmental dysplasia of the hip. J Pediatr Orthop. 2007;27(2):192–197. doi: 10.1097/01.bpb.0000248567.49089.f0. - DOI - PubMed
    1. Ran L., Chen H., Pan Y., Lin Q., Canavese F., Chen S. Comparison between the Pavlik harness and the Tübingen hip flexion splint for the early treatment of developmental dysplasia of the hip. J Pediatr Orthop B. 2020;29(5):424–430. doi: 10.1097/BPB.0000000000000667. - DOI - PubMed
    1. Nakamura J., Kamegaya M., Saisu T., Someya M., Koizumi W., Moriya H. Treatment for developmental dysplasia of the hip using the Pavlik harness. J Bone Joint Surg Br. 2007;89-B(2):230–235. doi: 10.1302/0301-620X.89B2.18057. - DOI - PubMed

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