Materiały źródłowe

• #1 Developmental dysplasia of the hip: Treatment and outcome – UpToDate

  https://www.uptodate.com/contents/developmental-dysplasia-of-the-hip-treatment-and-outcome

  Developmental dysplasia of the hip (DDH) describes a spectrum of conditions related to the development of the hip in infants and young children. It encompasses abnormal development of the acetabulum and proximal femur and mechanical instability of the hip joint (table 1). […] Treatment of DDH is initiated with referral to a pediatric orthopedic surgeon or other orthopedic surgeon who is familiar with the diagnosis and treatment of DDH. The treatment and outcome of DDH in otherwise healthy children will be reviewed here. […] Specific terms describing the position, stability, and shape of the hip in infants and children with DDH are defined below: […] Dislocation – There is a complete loss of contact between the femoral head and the acetabulum. […] Subluxation – The femoral head is partially outside of the acetabulum, but remains in contact.

• #2 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Treatment of developmental dysplasia of the hip aims to provide an optimal environment for the normal growth of the femoral head and acetabulum. Therefore, a high suspicion index and routine surveillance are needed to detect DDH and prevent complications. Treatment modalities like abduction splinting, closed reduction, and open reduction are available to establish optimal contact between the femoral head and the acetabulum. Double diapering is likely harmless but is not an effective treatment. The following management approaches are frequently implemented depending on the patient’s age and severity of hip dysplasia: […] Patients aged 0 to 4 weeks: Mild instability without a dislocatable hip can be observed. Early referral to an orthopedic surgeon experienced in treating developmental dysplasia of the hip will be optimal if the hips are dislocatable. The application of abduction splints (ie, Pavlik harness) will determined by the attending orthopedic surgeon. However, a study by Larson JE et al concluded that waiting up to 30 days before initiation of treatment showed no significant difference in the outcome.

• #3 Treatment for Developmental Dysplasia of the Hip or DDH | HSS

  https://www.hss.edu/conditions_developmental-dysplasia-of-the-hip-ddh.asp

  Some mild forms of developmental hip dysplasia in children particularly those in infants can correct on their own with time. […] Early intervention is essential to ensure the bones that make up the hip joint develop properly. Incorrect growth in either the ball or socket can cause formation problems in the other. The goal is to achieve and maintain joint congruity. […] When treatment is required, the first choice for children under six months old is nonsurgical, using a Pavlik harness. […] The Pavlik harness is a soft brace that gently redirects the head of the femur into the depth of the socket or acetabulum, which stimulates normal development of the joint. […] Treatment with the Pavlik harness is successful in about 85% of dislocated hips in children under six months of age. […] For the small number of patients in whom treatment with the Pavlik harness is not successful, and for children in whom the diagnosis is not made until after they are six months old, the orthopedist may recommend either a closed reduction or open reduction surgery.

• #4 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  Developmental dysplasia of the hip refers to a continuum of abnormalities in the immature hip that can range from subtle dysplasia to dislocation. […] Bracing is first-line treatment in children younger than six months. Surgery is an option for children in whom nonoperative treatment has failed and in children diagnosed after six months of age. […] It is important to diagnose developmental dysplasia of the hip early to improve treatment results and to decrease the risk of complications. […] The goal of treatment in DDH is to achieve and maintain reduction of the femoral head in the true acetabulum by closed or open means. The earlier treatment is initiated, the greater the success and the lower the incidence of residual dysplasia and long-term complications. […] In newborns and infants up to six months of age, closed reduction and immobilization in a Pavlik harness is the treatment of choice.

• #5 Treatment for Developmental Dysplasia of the Hip or DDH | HSS

  https://www.hss.edu/conditions_developmental-dysplasia-of-the-hip-ddh.asp

  Some mild forms of developmental hip dysplasia in children particularly those in infants can correct on their own with time. […] Early intervention is essential to ensure the bones that make up the hip joint develop properly. Incorrect growth in either the ball or socket can cause formation problems in the other. The goal is to achieve and maintain joint congruity. […] When treatment is required, the first choice for children under six months old is nonsurgical, using a Pavlik harness. […] The Pavlik harness is a soft brace that gently redirects the head of the femur into the depth of the socket or acetabulum, which stimulates normal development of the joint. […] Treatment with the Pavlik harness is successful in about 85% of dislocated hips in children under six months of age. […] For the small number of patients in whom treatment with the Pavlik harness is not successful, and for children in whom the diagnosis is not made until after they are six months old, the orthopedist may recommend either a closed reduction or open reduction surgery.

• #6 Developmental Dysplasia of the Hip (DDH) – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/developmental-dislocation-dysplasia-of-the-hip-ddh/

  When DDH is detected at birth, it can usually be corrected with the use of a harness or brace. […] If the hip is not dislocated at birth, the condition may not be noticed until the child begins walking. At this time, treatment is more complicated, with less predictable results. […] Treatment methods depend on a child’s age as well as the severity of the DDH. […] The baby may be placed in a soft positioning device, called a Pavlik harness, for 1 to 3 months to keep the thighbone in the socket. This special brace is designed to hold the hip in the proper position while allowing free movement of the legs and easy diaper care. The Pavlik harness helps tighten the ligaments around the hip joint and promotes normal hip socket formation. […] Similar to newborn treatment, a baby’s thighbone is repositioned in the socket using a harness or similar device. This method is usually successful, even with hips that are initially dislocated.

• #7 Developmental dysplasia of the hip (DDH) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/developmental-dysplasia-hip-ddh

  Specific treatment for DDH will be determined by your baby’s physician based on: […] Your baby’s gestational age, overall health, and medical history […] The severity of the condition based on physical exam and imaging […] Your baby’s tolerance for procedures or therapies […] Your opinion or preference […] The goal of treatment is to put the femoral head back into the socket of the hip and to deepen the socket so that the hip can develop normally. Treatment options vary for babies and may include: […] The Pavlik harness is used on babies up to 6 months of age to guide the hip into place, while allowing the legs to move to some extent. The harness is put on by your baby’s physician and is usually worn full time for several weeks, then part-time for an additional number of weeks.

• #8

  https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh

  Developmental Dysplasia of the Hip is a disorder of abnormal development resulting in dysplasia, subluxation, and possible dislocation of the hip secondary to capsular laxity and mechanical instability. […] Treatment varies from Pavlik bracing to surgical reduction and osteotomies depending on the age of the patient, underlying etiology, and the severity of dysplasia. […] Non-operative treatment includes abduction splinting/bracing (Pavlik harness) for patients 6 months old and with a reducible hip. […] Closed reduction and spica casting is indicated for patients 6-18 months old or in cases of failure of Pavlik treatment. […] Operative treatment options include open reduction and spica casting for patients 18 months old or those with failure of closed reduction, as well as open reduction and femoral osteotomy for 2-year-olds with residual hip dysplasia.

• #9 Developmental dysplasia of the hip (DDH) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/developmental-dysplasia-of-the-hip-ddh

  Treatment includes special harnesses, or operations and casts, depending on the age of the child at diagnosis. […] A baby born with a dislocated hip can be successfully treated with a Pavlik harness. This device holds the joint in place while the baby’s skeleton grows and matures. Subsequent x-rays will track the hip joint’s progress. The Pavlik harness is effective in over 85 per cent of cases. Most babies will require the harness for between six and 12 weeks, and do not appear to be distressed by its use. […] If a baby is diagnosed with a dislocated hip when they are six months old or more, then an anaesthetic will be required before the hip is manipulated into its proper position. An operation may also be needed. A hip cast applied after surgery helps to keep the hip joint in place, and subsequent x-rays will track the hip joint’s progress. […] Most babies born with successfully treated DDH don’t have any hip problems in later life. However, some may develop arthritis in the affected joint in their later years.

• #10 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Patients aged 1 to 6 months: Abduction devices can be tried, including the Pavlik harness, Von Rosen splint, Lausanne-developed abduction brace, Ilfeld orthosis, and Frejka pillow. The Pavlik harness is a widely used device for developmental dysplasia of the hip, consisting of an anterior strap that flexes the hip at 90 and prevents extension, along with a posterior strap to prevent adduction. The device is worn for 23 hours daily for at least 6 weeks or until the hip is stable. […] Patients aged 6 to 18 months: For infants diagnosed with developmental dysplasia of the hip at this age or those who have failed abduction devices, closed reduction with a hip spica cast is preferred. Under general anesthesia, the hip is placed in 90 to 100 flexion and 40 to 50 abduction. The failure rate is about 13.6%.

• #11 Pediatric Developmental Dysplasia of the Hip (DDH) | Children’s Healthcare of Atlanta

  https://www.choa.org/medical-services/orthopedics/hip-program/developmental-dysplasia-of-the-hip

  Our team of pediatric orthopedic specialists are specially trained to treat infants and children with hip dysplasia, which misshapes the ball or socket of the hip joint and causes the join to loosen. […] The goal of treating a hip condition like DDH in a child is to put the ball back into the hip socket so the hip can develop normally. Some hips do not continue to develop normally and need more treatment. […] Treatment for your child is based on: Age, Extent of hip dysplasia, Medical history, Tolerance to medicine, procedures and therapies. […] Treatment options may include: Pavlik harness: A tool for babies up to 6 months old, this harness keeps the hip in the right place while allowing your childs legs to move and is usually worn for at least six weeks. Its important for a doctor to monitor the hips as your child grows. The hips may not fully develop, requiring further treatment.

• #12 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Patients aged 1 to 6 months: Abduction devices can be tried, including the Pavlik harness, Von Rosen splint, Lausanne-developed abduction brace, Ilfeld orthosis, and Frejka pillow. The Pavlik harness is a widely used device for developmental dysplasia of the hip, consisting of an anterior strap that flexes the hip at 90 and prevents extension, along with a posterior strap to prevent adduction. The device is worn for 23 hours daily for at least 6 weeks or until the hip is stable. […] Patients aged 6 to 18 months: For infants diagnosed with developmental dysplasia of the hip at this age or those who have failed abduction devices, closed reduction with a hip spica cast is preferred. Under general anesthesia, the hip is placed in 90 to 100 flexion and 40 to 50 abduction. The failure rate is about 13.6%.

• #13 Developmental Dysplasia of the Hip (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/ddh.html

  Most infants treated for DDH develop into active, healthy kids and have no hip problems. […] A pediatric orthopedic surgeon (a specialist in children’s bone conditions) cares for babies and kids with DDH. The goal of care is to get the ball of the hip in the socket and keep it there, so the joint can grow normally. […] The orthopedic surgeon chooses the treatment based on the child’s age. Options include: bracing, a closed reduction and casting, an open reduction (surgery) and casting. […] Treatment for babies younger than 6 months old usually is a brace. The brace used most often is a Pavlik harness. It has a shoulder harness that attaches to foot stirrups. It puts the baby’s legs into a position that guides the ball of the hip joint into the socket. […] Treatment with the Pavlik harness often lasts about 612 weeks. While wearing the harness, the baby has a checkup every 13 weeks with hip ultrasounds and exams. During the visit, the medical team can adjust the harness if needed.

• #14

  https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh

  Open reduction and pelvic osteotomy is indicated for 2-year-olds with severe dysplasia accompanied by significant radiographic changes on the acetabular side. […] The goals of abduction splinting/bracing (Pavlik harness) are to achieve early concentric reduction to prevent future degeneration of the hip. […] If Pavlik harness fails, consider converting to a semi-rigid abduction brace with weekly ultrasounds for an additional 3-4 weeks before considering further intervention. […] Complications specific to Pavlik harness treatment include AVN, transient femoral nerve palsy, and Pavlik disease. […] Overall success rate of Pavlik harness treatment is 90%, dependent upon age at initiation of treatment and time spent in the harness.

• #15 Developmental Dysplasia of the Hip (DDH)

  https://patient.info/doctor/developmental-dysplasia-of-the-hip-pro

  A dynamic flexion-abduction orthosis (Pavlik harness), left in place at all times, is used to maintain hip reduction. Treatment should start as soon as the diagnosis has been confirmed. […] […] The harness can be adjusted as the child grows and the hip stabilises. […] […] One study showed that when harness treatment was started by 90 days of age, only 5.7% of babies required further treatment. […] […] The main risks of splinting are avascular necrosis and a temporary femoral nerve palsy. […] […] Harness or splint treatment is much less successful if it is started after the age of 6-8 weeks. […] […] A Pavlik harness is contra-indicated in children older than 4.5-6 months and when the hip is irreducible. […] […] Several small studies have shown that stable hips with mild dysplasia can be observed safely for six weeks before a decision to treat is made. […]

• #16 Planning Treatment for Children – International Hip Dysplasia Institute

  https://hipdysplasia.org/infant-child/planning-treatment-for-children/

  The treatment for Hip Dysplasia may not be as straight forward as one may think. Treatment depends on the age of the child and the amount of hip displacement. The purpose of treatment is to hold the hip in the socket until the ligaments go back to normal and to allow time for the socket and bone to grow to their proper shape. Often the dislocated hip of a newborn baby goes back into the socket very easily because the mothers hormones that relax ligaments are still in the baby. Dislocated or unstable hips in newborn infants can usually be held in place by a brace or harness that holds the legs in a position while the socket and ligaments become more stable. Most doctors recommend full-time wear for 6-12 weeks but some doctors allow removal for bathing and diaper changes as long as the legs are kept apart to keep the hips pointed at the socket. Treatment is similar to treatment in newborn infants in this age group. A fixed abduction brace can be used when the hip is mildly unstable or when it can easily go back into the socket. If the hip is completely dislocated and stuck in a dislocated position, then the Pavlik Harness can sometimes put the hip back in the socket over a period of 2-4 weeks. Treatment with the Pavlik Harness should be successful within four weeks or another form of treatment is usually recommended. Prolonged treatment with a Pavlik Harness while the hip remains dislocated may damage the wall of the socket. Manual closed reduction under general anesthesia is typical for this age group. The most common treatment for this age group is for the surgeon to manipulate the hip back into the socket under general anesthesia and then apply a body cast called a spica cast to hold the hip in position for several months while it heals and becomes more stable. Occasionally, surgery is recommended without trying closed reduction because the dislocation is more severe or because bone changes have already occurred. In this age group, open reduction surgery is almost always performed through an anterior approach to put the hip back into the joint, repair the ligaments, and to realign the bones. Reduction is rarely recommended in older children with completely dislocated hips because the bone changes are permanent by this age. Hip dysplasia with partially displaced hips can still be treated in older children and adolescents.

• #17 Developmental Dysplasia Of The Hip – OrthoPaedia

  https://www.orthopaedia.com/developmental-dysplasia-of-the-hip/

  The goal of treatment is to reduce and maintain the femoral head in the acetabulum as early as possible to allow the hip joint to develop normally. […] The standard of care for DDH diagnosed before 6 months of age is treatment in a dynamic hip brace (eg, Pavlik harness) that maintains the hips in a flexed and abducted position. These devices gently nudge the femoral head into the correct position and prevent extension and adduction of the hips — the maneuvers in the Barlow test that would dislocate the hip. […] These devices are worn for 23 hours/day for at least 6 weeks. It is critical that treatment is discontinued if the hip is not reduced by 4 weeks, as erosions of the pelvis may be caused. The overall success rate is 90%. […] Children who are diagnosed between 6-18 months old or who failed brace treatment are typically treated with closed reduction and spica casting. A closed reduction procedure involves manually reducing the hip joint while the patient is sedated. A hip arthrogram (dye injected into the joint) is obtained to evaluate for a concentric reduction. Children are then immobilized in a spica cast to maintain the hip in a good position. […] Long-term follow up is essential as residual dysplasia may occur as often as 10-20% even after successful treatment of DDH. Occasionally, additional surgeries are required later in life to ensure proper development of the hip socket in order to minimize the risk of early osteoarthritis.

• #18 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Treatment of developmental dysplasia of the hip aims to provide an optimal environment for the normal growth of the femoral head and acetabulum. Therefore, a high suspicion index and routine surveillance are needed to detect DDH and prevent complications. Treatment modalities like abduction splinting, closed reduction, and open reduction are available to establish optimal contact between the femoral head and the acetabulum. Double diapering is likely harmless but is not an effective treatment. The following management approaches are frequently implemented depending on the patient’s age and severity of hip dysplasia: […] Patients aged 0 to 4 weeks: Mild instability without a dislocatable hip can be observed. Early referral to an orthopedic surgeon experienced in treating developmental dysplasia of the hip will be optimal if the hips are dislocatable. The application of abduction splints (ie, Pavlik harness) will determined by the attending orthopedic surgeon. However, a study by Larson JE et al concluded that waiting up to 30 days before initiation of treatment showed no significant difference in the outcome.

• #19

  https://step2.medbullets.com/orthopedics/120517/developmental-dysplasia-of-the-hip-ddh

  A 4-month old female was referred by a local clinic for evaluation of asymmetric thigh creases during routine checkup. Physical exam revealed that the left lower limb was shorter than the right and lay externally rotated. Hip abduction was limited to 30 degrees. Ortolani’s test was positive. Radiographs revealed a superiorly displaced left proximal femoral metaphysis and a shallow, hypoplastic left acetabulum. The infant was treated in a Pavlik abduction harness for congenital hip dislocation. […] Pavlik harness (abduction bracing) keep hips flexed and abducted. […] do not abduct 60 degrees (increased risk of AVN). […] Can observe until up to 4 weeks of age to allow for spontaneous resolution without risk of jeopardizing future interventions. […] 6-18 months old closed reduction and hip spica cast. […] 18 months old open reduction followed by hip spica cast. […] Better if treatment begins earlier.

• #20 Developmental Dysplasia of the Hip (DDH)

  https://patient.info/doctor/developmental-dysplasia-of-the-hip-pro

  A dynamic flexion-abduction orthosis (Pavlik harness), left in place at all times, is used to maintain hip reduction. Treatment should start as soon as the diagnosis has been confirmed. […] […] The harness can be adjusted as the child grows and the hip stabilises. […] […] One study showed that when harness treatment was started by 90 days of age, only 5.7% of babies required further treatment. […] […] The main risks of splinting are avascular necrosis and a temporary femoral nerve palsy. […] […] Harness or splint treatment is much less successful if it is started after the age of 6-8 weeks. […] […] A Pavlik harness is contra-indicated in children older than 4.5-6 months and when the hip is irreducible. […] […] Several small studies have shown that stable hips with mild dysplasia can be observed safely for six weeks before a decision to treat is made. […]

• #21

  https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh

  Open reduction and pelvic osteotomy is indicated for 2-year-olds with severe dysplasia accompanied by significant radiographic changes on the acetabular side. […] The goals of abduction splinting/bracing (Pavlik harness) are to achieve early concentric reduction to prevent future degeneration of the hip. […] If Pavlik harness fails, consider converting to a semi-rigid abduction brace with weekly ultrasounds for an additional 3-4 weeks before considering further intervention. […] Complications specific to Pavlik harness treatment include AVN, transient femoral nerve palsy, and Pavlik disease. […] Overall success rate of Pavlik harness treatment is 90%, dependent upon age at initiation of treatment and time spent in the harness.

• #22 Pediatric Developmental Dysplasia of the Hip (DDH) | Children’s Healthcare of Atlanta

  https://www.choa.org/medical-services/orthopedics/hip-program/developmental-dysplasia-of-the-hip

  Hip abduction brace: A hard, plastic brace with foam padding that holds the hips more firmly than a Pavlik harness, this brace is normally worn for at least three months. […] Surgery: This option allows a doctor to manually put your childs hip in place. If the other methods are not successful, or if hip dysplasia is diagnosed after 6 months old, surgery and casting may be needed. […] Physical therapy: Participating in physical therapy allows your child to perform exercises and stretches with a specialist to help make the muscles around the hip stronger and help teach your child how to walk again.

• #23 Developmental Dysplasia of the Hip (DDH) – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/developmental-dislocation-dysplasia-of-the-hip-ddh/

  If the hip will not stay in position using a harness, your child’s doctor may try an abduction brace made of firmer material that will keep your baby’s legs in position. […] In some cases, a closed reduction procedure is required. Your child’s doctor will gently move your baby’s thighbone into proper position, then apply a body cast (spica cast) to hold the bones in place. This procedure is done while the baby is under anesthesia. […] If a closed reduction procedure is not successful at putting the thighbone in its proper position, open surgery is necessary. In this procedure, an incision is made at the baby’s hip that allows the surgeon to clearly see the bones and soft tissues. […] In some cases, the thighbone will be shortened to properly fit the bone into the socket. […] Open surgery is typically necessary to realign the hip. A spica cast is usually applied to maintain the hip in the socket.

• #24

  https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh

  Open reduction and pelvic osteotomy is indicated for 2-year-olds with severe dysplasia accompanied by significant radiographic changes on the acetabular side. […] The goals of abduction splinting/bracing (Pavlik harness) are to achieve early concentric reduction to prevent future degeneration of the hip. […] If Pavlik harness fails, consider converting to a semi-rigid abduction brace with weekly ultrasounds for an additional 3-4 weeks before considering further intervention. […] Complications specific to Pavlik harness treatment include AVN, transient femoral nerve palsy, and Pavlik disease. […] Overall success rate of Pavlik harness treatment is 90%, dependent upon age at initiation of treatment and time spent in the harness.

• #25 Developmental Dysplasia of the Hip (DDH)

  https://patient.info/doctor/developmental-dysplasia-of-the-hip-pro

  A dynamic flexion-abduction orthosis (Pavlik harness), left in place at all times, is used to maintain hip reduction. Treatment should start as soon as the diagnosis has been confirmed. […] […] The harness can be adjusted as the child grows and the hip stabilises. […] […] One study showed that when harness treatment was started by 90 days of age, only 5.7% of babies required further treatment. […] […] The main risks of splinting are avascular necrosis and a temporary femoral nerve palsy. […] […] Harness or splint treatment is much less successful if it is started after the age of 6-8 weeks. […] […] A Pavlik harness is contra-indicated in children older than 4.5-6 months and when the hip is irreducible. […] […] Several small studies have shown that stable hips with mild dysplasia can be observed safely for six weeks before a decision to treat is made. […]

• #26 Developmental Dysplasia of the Hip (DDH)

  https://patient.info/doctor/developmental-dysplasia-of-the-hip-pro

  A dynamic flexion-abduction orthosis (Pavlik harness), left in place at all times, is used to maintain hip reduction. Treatment should start as soon as the diagnosis has been confirmed. […] […] The harness can be adjusted as the child grows and the hip stabilises. […] […] One study showed that when harness treatment was started by 90 days of age, only 5.7% of babies required further treatment. […] […] The main risks of splinting are avascular necrosis and a temporary femoral nerve palsy. […] […] Harness or splint treatment is much less successful if it is started after the age of 6-8 weeks. […] […] A Pavlik harness is contra-indicated in children older than 4.5-6 months and when the hip is irreducible. […] […] Several small studies have shown that stable hips with mild dysplasia can be observed safely for six weeks before a decision to treat is made. […]

• #27 Developmental Dysplasia of the Hip (DDH) – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/congenital-musculoskeletal-anomalies/developmental-dysplasia-of-the-hip-ddh

  Developmental dysplasia of the hip (formerly congenital dislocation of the hip) is abnormal development of the hip joint. […] Treatment of DDH […] Early treatment of the dysplasia is critical. With any delay, the potential for correction without surgery decreases steadily. The hip usually can be reduced immediately after birth, and with growth, the acetabulum can form a nearly normal joint. […] Treatment is with devices, most commonly the Pavlik harness, which hold the affected hips abducted and externally rotated. The Frejka pillow and other splints may help. […] If the dysplasia persists past the age of 6 months, surgical correction is usually needed. […] Padded diapers and double or triple diapering are not effective measures for correcting developmental dysplasia of the hip.

• #28 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Patients aged 1 to 6 months: Abduction devices can be tried, including the Pavlik harness, Von Rosen splint, Lausanne-developed abduction brace, Ilfeld orthosis, and Frejka pillow. The Pavlik harness is a widely used device for developmental dysplasia of the hip, consisting of an anterior strap that flexes the hip at 90 and prevents extension, along with a posterior strap to prevent adduction. The device is worn for 23 hours daily for at least 6 weeks or until the hip is stable. […] Patients aged 6 to 18 months: For infants diagnosed with developmental dysplasia of the hip at this age or those who have failed abduction devices, closed reduction with a hip spica cast is preferred. Under general anesthesia, the hip is placed in 90 to 100 flexion and 40 to 50 abduction. The failure rate is about 13.6%.

• #29

  https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh

  Developmental Dysplasia of the Hip is a disorder of abnormal development resulting in dysplasia, subluxation, and possible dislocation of the hip secondary to capsular laxity and mechanical instability. […] Treatment varies from Pavlik bracing to surgical reduction and osteotomies depending on the age of the patient, underlying etiology, and the severity of dysplasia. […] Non-operative treatment includes abduction splinting/bracing (Pavlik harness) for patients 6 months old and with a reducible hip. […] Closed reduction and spica casting is indicated for patients 6-18 months old or in cases of failure of Pavlik treatment. […] Operative treatment options include open reduction and spica casting for patients 18 months old or those with failure of closed reduction, as well as open reduction and femoral osteotomy for 2-year-olds with residual hip dysplasia.

• #30 Planning Treatment for Children – International Hip Dysplasia Institute

  https://hipdysplasia.org/infant-child/planning-treatment-for-children/

  The treatment for Hip Dysplasia may not be as straight forward as one may think. Treatment depends on the age of the child and the amount of hip displacement. The purpose of treatment is to hold the hip in the socket until the ligaments go back to normal and to allow time for the socket and bone to grow to their proper shape. Often the dislocated hip of a newborn baby goes back into the socket very easily because the mothers hormones that relax ligaments are still in the baby. Dislocated or unstable hips in newborn infants can usually be held in place by a brace or harness that holds the legs in a position while the socket and ligaments become more stable. Most doctors recommend full-time wear for 6-12 weeks but some doctors allow removal for bathing and diaper changes as long as the legs are kept apart to keep the hips pointed at the socket. Treatment is similar to treatment in newborn infants in this age group. A fixed abduction brace can be used when the hip is mildly unstable or when it can easily go back into the socket. If the hip is completely dislocated and stuck in a dislocated position, then the Pavlik Harness can sometimes put the hip back in the socket over a period of 2-4 weeks. Treatment with the Pavlik Harness should be successful within four weeks or another form of treatment is usually recommended. Prolonged treatment with a Pavlik Harness while the hip remains dislocated may damage the wall of the socket. Manual closed reduction under general anesthesia is typical for this age group. The most common treatment for this age group is for the surgeon to manipulate the hip back into the socket under general anesthesia and then apply a body cast called a spica cast to hold the hip in position for several months while it heals and becomes more stable. Occasionally, surgery is recommended without trying closed reduction because the dislocation is more severe or because bone changes have already occurred. In this age group, open reduction surgery is almost always performed through an anterior approach to put the hip back into the joint, repair the ligaments, and to realign the bones. Reduction is rarely recommended in older children with completely dislocated hips because the bone changes are permanent by this age. Hip dysplasia with partially displaced hips can still be treated in older children and adolescents.

• #31 Developmental Dysplasia of the Hip (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/ddh.html

  Rarely, the harness isn’t able to keep the ball of the hip in the socket. Then, doctors might do either: a closed reduction (manually moving the ball back into the socket) and casting, an open reduction (surgery) and casting. […] A child might need a closed reduction if: The harness was not successful at keeping the ball of the hip in the socket, a baby starts care after age 6 months. […] For a closed reduction, the baby gets medicine (general anesthesia) to sleep through the procedure and not feel pain. […] A child might need surgery (an open reduction) if: The closed reduction was not successful at keeping the ball of the hip in the socket, the child is older than 18 months when starting treatment. […] Sometimes, the orthopedic surgeon also does a surgery on the pelvic bone to deepen a very shallow hip socket, especially for a child older than 18 months.

• #32 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Patients aged 1 to 6 months: Abduction devices can be tried, including the Pavlik harness, Von Rosen splint, Lausanne-developed abduction brace, Ilfeld orthosis, and Frejka pillow. The Pavlik harness is a widely used device for developmental dysplasia of the hip, consisting of an anterior strap that flexes the hip at 90 and prevents extension, along with a posterior strap to prevent adduction. The device is worn for 23 hours daily for at least 6 weeks or until the hip is stable. […] Patients aged 6 to 18 months: For infants diagnosed with developmental dysplasia of the hip at this age or those who have failed abduction devices, closed reduction with a hip spica cast is preferred. Under general anesthesia, the hip is placed in 90 to 100 flexion and 40 to 50 abduction. The failure rate is about 13.6%.

• #33 Developmental Dysplasia of the Hip (DDH) Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1248135-treatment

  Treatment of DDH begins with careful examination of the newborn. If evidence of instability is present, a Pavlik harness should be considered and, if used, fitted appropriately. […] The use of an abduction brace after a failure of the Pavlik harness has been suggested. […] In patients older than 6 months, the success rate with a Pavlik harness is less than 50%; therefore, this therapy should not be used in these patients. […] Closed reduction is typically performed with the aid of arthrography, which is used to determine the adequacy of the reduction. […] Open reduction is the treatment of choice for DDH in children who are older than 2 years at the time of the initial diagnosis or in whom attempts at closed reduction have failed. […] Pelvic osteotomy may be needed for residual hip dysplasia. […] If open reduction is performed in a child older than 4 years with significant hip dysplasia, an acetabular procedure should be considered at the time of open reduction.

• #34 Developmental Dysplasia Of The Hip – OrthoPaedia

  https://www.orthopaedia.com/developmental-dysplasia-of-the-hip/

  The goal of treatment is to reduce and maintain the femoral head in the acetabulum as early as possible to allow the hip joint to develop normally. […] The standard of care for DDH diagnosed before 6 months of age is treatment in a dynamic hip brace (eg, Pavlik harness) that maintains the hips in a flexed and abducted position. These devices gently nudge the femoral head into the correct position and prevent extension and adduction of the hips — the maneuvers in the Barlow test that would dislocate the hip. […] These devices are worn for 23 hours/day for at least 6 weeks. It is critical that treatment is discontinued if the hip is not reduced by 4 weeks, as erosions of the pelvis may be caused. The overall success rate is 90%. […] Children who are diagnosed between 6-18 months old or who failed brace treatment are typically treated with closed reduction and spica casting. A closed reduction procedure involves manually reducing the hip joint while the patient is sedated. A hip arthrogram (dye injected into the joint) is obtained to evaluate for a concentric reduction. Children are then immobilized in a spica cast to maintain the hip in a good position. […] Long-term follow up is essential as residual dysplasia may occur as often as 10-20% even after successful treatment of DDH. Occasionally, additional surgeries are required later in life to ensure proper development of the hip socket in order to minimize the risk of early osteoarthritis.

• #35 Developmental dysplasia of the hip (DDH)

  https://www.rch.org.au/kidsinfo/fact_sheets/Developmental_dysplasia_of_the_hip_DDH/

  If splinting does not work, your child may need a procedure called a closed reduction. Closed reduction means the hip joint is repaired without surgery. The hip joint is moved into the correct position while your child is asleep under anaesthetic. […] Sometimes, when the above treatments do not work or DDH is diagnosed later than six months of age, your child may need open reduction surgery (when surgery is done through a cut in the body). […] After open reduction surgery (and sometimes after closed reduction surgery) your child will need a hip spica a plaster cast that covers your child’s body from the knees to the waist. Hip spicas may need to be worn for several months. […] Occasionally, when DDH is diagnosed late, more surgery to the thigh or pelvic bones may be needed to make sure the hip joint stays in place. This surgery is called an osteotomy.

• #36 Developmental Dysplasia of the Hip (DDH) – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/developmental-dislocation-dysplasia-of-the-hip-ddh/

  In many children with DDH, a body cast and/or brace is required to keep the hip bone in the joint during healing. The cast may be needed for 2 to 3 months. Your child’s doctor may change the cast during this time period. […] If diagnosed early and treated successfully, children are able to develop a normal hip joint and should have no limitation in function. Left untreated, DDH can lead to pain and osteoarthritis by early adulthood. It may produce a difference in leg length or decreased agility. […] Even with appropriate treatment, hip deformity and osteoarthritis may develop later in life. This is especially true when treatment begins after the age of 2.

• #37 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Patients aged 1 to 6 months: Abduction devices can be tried, including the Pavlik harness, Von Rosen splint, Lausanne-developed abduction brace, Ilfeld orthosis, and Frejka pillow. The Pavlik harness is a widely used device for developmental dysplasia of the hip, consisting of an anterior strap that flexes the hip at 90 and prevents extension, along with a posterior strap to prevent adduction. The device is worn for 23 hours daily for at least 6 weeks or until the hip is stable. […] Patients aged 6 to 18 months: For infants diagnosed with developmental dysplasia of the hip at this age or those who have failed abduction devices, closed reduction with a hip spica cast is preferred. Under general anesthesia, the hip is placed in 90 to 100 flexion and 40 to 50 abduction. The failure rate is about 13.6%.

• #38 Developmental Dysplasia of the Hip (DDH)

  https://patient.info/doctor/developmental-dysplasia-of-the-hip-pro

  Surgery is indicated for those who do not respond to early splint or harness treatment and for those who are diagnosed late and are not suitable for splint or harness treatment. […] […] The most common operation is closed reduction with adductor or psoas tenotomy (to decrease adduction contracture), followed by 3-4 months in a plaster cast or abduction brace. […] […] The older the child, the more likely an extensive procedure will be required with open reduction and soft tissue stabilisation of the joint, followed by a cast. […] […] Over the age of 18-24 months, an additional pelvic and/or femoral osteotomy is often required. […] […] Results worsen the older the child is at the time of surgery. Osteonecrosis and re-dislocation predict a poor functional result. A child aged over 3, with highly dysplastic acetabula, may have a better outcome if left untreated, as they may not have sufficient acetabular growth to remodel a surgically reduced hip. […] […] Follow-up is required at least until the hip is clinically stable and imaging shows a stable, centred, normal hip. […] […] The length of follow-up and the frequency of radiographic examinations are still debated. […] […] Follow-up may reveal acetabular dysplasia in the contralateral hip.

• #39 Surgery for Developmental Hip Dysplasia | NYU Langone Health

  https://nyulangone.org/conditions/developmental-hip-dysplasia/treatments/surgery-for-developmental-hip-dysplasia

  Doctors at NYU Langone may recommend surgery for babies who cant be helped with nonsurgical treatment and for older children and adults who have complications of developmental hip dysplasia. […] Those who have tried nonsurgical treatments, or those in whom nonsurgical treatments are unlikely to offer significant improvement, have several surgical options. General anesthesia is used during all of these procedures. […] Children with developmental hip dysplasia receive surgical treatment through Hassenfeld Childrens Hospital at NYU Langone. […] Tenotomy is an outpatient surgical procedure in which the doctor loosens a tendon in the hip joint that has become too tight due to incorrect positioning. […] In open reduction, the surgeon makes a small incision in the groin and removes excess tissue to make more room in the hip socket.

• #40 Developmental Dysplasia of the Hip (DDH)

  https://www.gillettechildrens.org/conditions-care/developmental-dysplasia-of-the-hip-ddh

  During this surgery, a pediatric orthopedic surgeon releases a tight adductor or groin tendon. This is often done in combination with other hip surgeries. […] This surgery includes the cutting of bone. A pediatric orthopedic surgeon might cut or realign the femur (thighbone) to place the ball in a better position in the socket. In some cases, the surgeon might also cut the pelvic bone to improve the sockets shape. […] If your child has DDH, your family will likely work with pediatric orthopedic specialistsand Gillette is home to one of the countrys largest groups of pediatric orthopedic surgeons. […] An integrated team will help you navigate the services your child needsincluding treatment of conditions associated with DDH, such as clubfoot, gait abnormalities, a limb length difference, early arthritis or hip pain. It’s important to have hips examined by a skilled medical team, including a pediatric ultrasonographer.

• #41 Developmental Dysplasia of the Hip in Children (Ambulatory Care)

  https://www.drugs.com/cg/developmental-dysplasia-of-the-hip-in-children-ambulatory-care.html

  Traction pulls on the hip or thigh bones to pull them back into place. A pin may be put in your child’s bone or cast, and hooked to ropes and a pulley. Weight is hung on the rope to help stretch the soft tissues around the hip bones. This helps the hip fit into the hip socket. […] Physical and occupational therapy may be needed. A physical therapist teaches your child exercises to help improve movement and strength. An occupational therapist teaches your child skills to help with daily activities. […] Take your child to physical and occupational therapy as directed. A physical therapist teaches your child exercises to help him or her improve movement and strength. An occupational therapist teaches your child skills to help with his or her daily activities.

• #42 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Patients aged 18 months to 8 years: Open reduction is preferred for children diagnosed with developmental dysplasia of the hip older than 18 months and infants who have failed closed reduction. Open reduction can correct anatomical abnormalities, including inverted labrum, neolimbus, pulvinar, and hypertrophied ligamentum. […] Acetabular Dysplasia: Children with shallow or vertical acetabulum are at risk of developing osteoarthritis due to edge loading. Patients presenting with acetabular dysplasia up to the age of 5, without dislocation, can be treated with part-time or full-time abduction orthosis. After 5 years of age, pelvic osteotomies (eg, Salter, Pemberton, and Dega) use a single cut to increase anterior or anterolateral coverage. If the patient has an open triradiate cartilage center, a triple cut (ie, triple innominate osteotomy) can be performed.

• #43

  https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh

  Developmental Dysplasia of the Hip is a disorder of abnormal development resulting in dysplasia, subluxation, and possible dislocation of the hip secondary to capsular laxity and mechanical instability. […] Treatment varies from Pavlik bracing to surgical reduction and osteotomies depending on the age of the patient, underlying etiology, and the severity of dysplasia. […] Non-operative treatment includes abduction splinting/bracing (Pavlik harness) for patients 6 months old and with a reducible hip. […] Closed reduction and spica casting is indicated for patients 6-18 months old or in cases of failure of Pavlik treatment. […] Operative treatment options include open reduction and spica casting for patients 18 months old or those with failure of closed reduction, as well as open reduction and femoral osteotomy for 2-year-olds with residual hip dysplasia.

• #44 Planning Treatment for Children – International Hip Dysplasia Institute

  https://hipdysplasia.org/infant-child/planning-treatment-for-children/

  The treatment for Hip Dysplasia may not be as straight forward as one may think. Treatment depends on the age of the child and the amount of hip displacement. The purpose of treatment is to hold the hip in the socket until the ligaments go back to normal and to allow time for the socket and bone to grow to their proper shape. Often the dislocated hip of a newborn baby goes back into the socket very easily because the mothers hormones that relax ligaments are still in the baby. Dislocated or unstable hips in newborn infants can usually be held in place by a brace or harness that holds the legs in a position while the socket and ligaments become more stable. Most doctors recommend full-time wear for 6-12 weeks but some doctors allow removal for bathing and diaper changes as long as the legs are kept apart to keep the hips pointed at the socket. Treatment is similar to treatment in newborn infants in this age group. A fixed abduction brace can be used when the hip is mildly unstable or when it can easily go back into the socket. If the hip is completely dislocated and stuck in a dislocated position, then the Pavlik Harness can sometimes put the hip back in the socket over a period of 2-4 weeks. Treatment with the Pavlik Harness should be successful within four weeks or another form of treatment is usually recommended. Prolonged treatment with a Pavlik Harness while the hip remains dislocated may damage the wall of the socket. Manual closed reduction under general anesthesia is typical for this age group. The most common treatment for this age group is for the surgeon to manipulate the hip back into the socket under general anesthesia and then apply a body cast called a spica cast to hold the hip in position for several months while it heals and becomes more stable. Occasionally, surgery is recommended without trying closed reduction because the dislocation is more severe or because bone changes have already occurred. In this age group, open reduction surgery is almost always performed through an anterior approach to put the hip back into the joint, repair the ligaments, and to realign the bones. Reduction is rarely recommended in older children with completely dislocated hips because the bone changes are permanent by this age. Hip dysplasia with partially displaced hips can still be treated in older children and adolescents.

• #45 Developmental Dysplasia of the Hip (DDH) – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/developmental-dislocation-dysplasia-of-the-hip-ddh/

  If the hip will not stay in position using a harness, your child’s doctor may try an abduction brace made of firmer material that will keep your baby’s legs in position. […] In some cases, a closed reduction procedure is required. Your child’s doctor will gently move your baby’s thighbone into proper position, then apply a body cast (spica cast) to hold the bones in place. This procedure is done while the baby is under anesthesia. […] If a closed reduction procedure is not successful at putting the thighbone in its proper position, open surgery is necessary. In this procedure, an incision is made at the baby’s hip that allows the surgeon to clearly see the bones and soft tissues. […] In some cases, the thighbone will be shortened to properly fit the bone into the socket. […] Open surgery is typically necessary to realign the hip. A spica cast is usually applied to maintain the hip in the socket.

• #46 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Patients aged 18 months to 8 years: Open reduction is preferred for children diagnosed with developmental dysplasia of the hip older than 18 months and infants who have failed closed reduction. Open reduction can correct anatomical abnormalities, including inverted labrum, neolimbus, pulvinar, and hypertrophied ligamentum. […] Acetabular Dysplasia: Children with shallow or vertical acetabulum are at risk of developing osteoarthritis due to edge loading. Patients presenting with acetabular dysplasia up to the age of 5, without dislocation, can be treated with part-time or full-time abduction orthosis. After 5 years of age, pelvic osteotomies (eg, Salter, Pemberton, and Dega) use a single cut to increase anterior or anterolateral coverage. If the patient has an open triradiate cartilage center, a triple cut (ie, triple innominate osteotomy) can be performed.

• #47 OrthoKids – Developmental Dysplasia of the Hip (DDH)

  https://orthokids.org/conditions/developmental-dysplasia-of-the-hip-(ddh)/

  If a closed reduction does not work, then an open reduction surgery is needed. Your surgeon will need to make an incision to remove tissue that is preventing the femoral head from staying in the acetabulum. […] After open reduction surgery, a spica cast is needed during healing. […] Open reduction surgery with shortening of the femur and pelvic osteotomy is usually needed to reduce the hip joint. A spica cast is used for 2 or 3 months to keep the hip reduced. Long term follow-up with X-rays is needed to make sure that your child’s hip continues to develop normally after treatment. Many infants who are treated early will have a normal hip and have full function. However, hip dysplasia may still be present after your child is treated correctly, and future surgery may be needed in some patients.

• #48 Child Treatment Methods – International Hip Dysplasia Institute

  https://hipdysplasia.org/infant-child/child-treatment-methods/

  This is done when it is suspected that tissue is keeping the head of the femur (the ball at the top of the thigh bone) from going back into the acetabulum (the socket). In young children, clearing out the hip joint may be all thats needed. In older children, the ligaments of the hip also need to be repaired. […] This is done when the hip socket needs repair. There are several different types of pelvic osteotomy and the choice depends on the particular shape of the socket needing repair and the surgeons experience. […] This is done when the upper end of the thigh bone needs to be tipped so the ball points deeper into the socket. This is sometimes called a Varus De-rotational Osteotomy (VDO or VDRO).

• #49 Developmental Dysplasia of the Hip | Loma Linda University Children’s Health

  https://lluch.org/conditions/developmental-dysplasia-of-hip

  Surgery. If the other methods dont work, or if DDH is diagnosed at age 6 months to 2 years, your child may need surgery to realign the hip. Your child may then have to wear a spica cast for up to 6 months after surgery. This special cast holds the hip in place as it heals. After the cast is removed, your child may need a special brace or physical therapy exercises to strengthen the muscles around the hip and in the legs. […] Treatment may include a Pavlik harness, casting, or surgery.

• #50

  https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh

  Open reduction and pelvic osteotomy is indicated for 2-year-olds with severe dysplasia accompanied by significant radiographic changes on the acetabular side. […] The goals of abduction splinting/bracing (Pavlik harness) are to achieve early concentric reduction to prevent future degeneration of the hip. […] If Pavlik harness fails, consider converting to a semi-rigid abduction brace with weekly ultrasounds for an additional 3-4 weeks before considering further intervention. […] Complications specific to Pavlik harness treatment include AVN, transient femoral nerve palsy, and Pavlik disease. […] Overall success rate of Pavlik harness treatment is 90%, dependent upon age at initiation of treatment and time spent in the harness.

• #51 Developmental Hip Dysplasia DDH

  https://www.jplrc.com/developmental-dysplasia-of-the-hip.html

  Your child may be too old to simply cut the femur and put the hip back in place because the „bowl” is no longer soft enough to sufficiently remodel and form a normal acetabulum. Usually up to the age of 4 years old, a child’s acetabulum can go on to form properly as long as the hip is put back in place. […] Beyond the age of 4 years old though, this ability to remodel decreases, and so we therefore need to cut the pelvis and help reshape it. […] Certain conditions which cause DDH are more likely to require more aggressive treatment, in the form of a pelvic osteotomy. […] Treating DDH: We prefer to begin treating DDH as soon as it is diagnosed because many times with proper early treatment, your child’s acetabulum can remodel on its own without the need for any surgery. […] A Pavlik Harness is a set of straps that brace the legs into the best position that can allow the hips to stay in place while the acetabulum properly remodels.

• #52 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Patients aged 18 months to 8 years: Open reduction is preferred for children diagnosed with developmental dysplasia of the hip older than 18 months and infants who have failed closed reduction. Open reduction can correct anatomical abnormalities, including inverted labrum, neolimbus, pulvinar, and hypertrophied ligamentum. […] Acetabular Dysplasia: Children with shallow or vertical acetabulum are at risk of developing osteoarthritis due to edge loading. Patients presenting with acetabular dysplasia up to the age of 5, without dislocation, can be treated with part-time or full-time abduction orthosis. After 5 years of age, pelvic osteotomies (eg, Salter, Pemberton, and Dega) use a single cut to increase anterior or anterolateral coverage. If the patient has an open triradiate cartilage center, a triple cut (ie, triple innominate osteotomy) can be performed.

• #53 Surgical treatment of developmental dysplasia of the hip in children – A monocentric study about 414 hips | SICOT-J

  https://www.sicot-j.org/articles/sicotj/full_html/2022/01/sicotj220022/sicotj220022.html

  Surgical treatment of developmental dysplasia of the hip in children A monocentric study about 414 hips […] No consensus exists about the open reduction of developmental dysplasia of the hip (DDH; age of surgery and the need for additional bone surgery). We report clinical and radiological outcomes of a large monocentric study. The objectives are to analyze outcomes and to give recommendations. The aim of surgery is to achieve a stable and concentric reduction while limiting the risk of complications, especially avascular necrosis of femoral head (AVN), redislocation or recurrence of acetabular dysplasia, and the need for secondary procedures. Surgery involves an open reduction of the femoral head with resection of the redundant capsule and the release of intra- and extra-articular soft tissues. Pelvic and/or femoral osteotomies may be necessary to maintain a stable and concentric reduction and avoid complications. We recommend a femoral shortening osteotomy for high dislocations (Tnnis 3 or 4) for children over 18 months and a pelvic osteotomy for children over 36 months or over 18 months with an acetabular index 25.

• #54 Surgical treatment of developmental dysplasia of the hip in children – A monocentric study about 414 hips | SICOT-J

  https://www.sicot-j.org/articles/sicotj/full_html/2022/01/sicotj220022/sicotj220022.html

  Surgical treatment of developmental dysplasia of the hip in children A monocentric study about 414 hips […] No consensus exists about the open reduction of developmental dysplasia of the hip (DDH; age of surgery and the need for additional bone surgery). We report clinical and radiological outcomes of a large monocentric study. The objectives are to analyze outcomes and to give recommendations. The aim of surgery is to achieve a stable and concentric reduction while limiting the risk of complications, especially avascular necrosis of femoral head (AVN), redislocation or recurrence of acetabular dysplasia, and the need for secondary procedures. Surgery involves an open reduction of the femoral head with resection of the redundant capsule and the release of intra- and extra-articular soft tissues. Pelvic and/or femoral osteotomies may be necessary to maintain a stable and concentric reduction and avoid complications. We recommend a femoral shortening osteotomy for high dislocations (Tnnis 3 or 4) for children over 18 months and a pelvic osteotomy for children over 36 months or over 18 months with an acetabular index 25.

• #55 Developmental Hip Dysplasia DDH

  https://www.jplrc.com/developmental-dysplasia-of-the-hip.html

  Up to 90% of babies with mild to moderate DDH can be safely treated with a Pavlik Harness, with good results. […] If your child is older than 6 months of age, or if the hip cannot be safely reduced with only a Pavlik Harness, we then need to consider a different treatment. […] In cases where we are unable to relocate the hip joint with a Closed Reduction, or if there are conditions that prevent the hip from safely staying in place despite the cast and soft tissue release(s), we then need to perform what is called an Open Reduction. […] In more moderate to severe DDH, we will sometimes need to not only look into the hip joint, but we may also need to cut the femur bone and either intentionally shorten it or move it so that the hip is reduced. […] For children with severe DDH, their hips are often not amenable to Pavlik Harness, Closed Reduction and sometimes even Open Reductions with only cutting the femur bone. […] With proper early treatment, mild to moderate DDH can oftentimes be completely reversed. Even patients with severe DDH, if treated early on and properly, can grow up to be adults with healthy hip joints.

• #56 Surgical treatment of developmental dysplasia of the hip in children – A monocentric study about 414 hips | SICOT-J

  https://www.sicot-j.org/articles/sicotj/full_html/2022/01/sicotj220022/sicotj220022.html

  In our series, 293 hips (72%) had stable reduction without AVN with good clinical and radiological outcomes. This compares favorably with previous reports in the literature. The clinical outcomes are better and the risk of AVN decreases significantly when a femoral osteotomy is performed. There were better radiological results when pelvic osteotomy was performed. The rate of residual dysplasia was higher when pelvic osteotomy was not performed. […] No international consensus regarding surgical treatment of DDH has been established. Our analysis showed a decrease in AVN with femoral shorting and a decrease in the rate of residual dysplasia in the event of a pelvic osteotomy for hips with an acetabular index greater than 25.

• #57 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Adolescent and Adult Hip Preservation Surgery: Patients who are presenting with hip pain and shallow acetabulum with radiographic findings of femoral head under coverage and closed triradiate cartilage but without signs of hip degeneration can be treated with a periacetabular osteotomy (PAO). Bernese PAO is a technique in which multiple cuts are made to modify and reorient acetabular cartilage while maintaining an intact posterior column.

• #58 Adolescent Acetabular Dysplasia (Idiopathic DDH) | Pediatric Orthopaedic Society of North America (POSNA)

  https://posna.org/physician-education/study-guide/adolescent-acetabular-dysplasia-(idiopathic-ddh)

  Periacetabular osteotomy is an effective treatment that can alter the natural history of dysplastic hips. […] The mainstay of treatment for hip instability secondary to acetabular dysplasia in the skeletally mature patient is the periacetabular osteotomy, as developed by Ganz. […] There is evidence that treatment of severe acetabular dysplasia (LCE 15) in hips with intact articular cartilage with acetabular reorientation can affect the natural history of hip dysplasia and prolong the longevity of the native hip. […] The first line treatment of acetabular dysplasia in moderate and mild cases is physical therapy, consisting of core, back and hip strengthening. […] Hip injections can be helpful for symptoms relating to labral pathology, but do not address underlying bony deficiencies.

• #59 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Adolescent and Adult Hip Preservation Surgery: Patients who are presenting with hip pain and shallow acetabulum with radiographic findings of femoral head under coverage and closed triradiate cartilage but without signs of hip degeneration can be treated with a periacetabular osteotomy (PAO). Bernese PAO is a technique in which multiple cuts are made to modify and reorient acetabular cartilage while maintaining an intact posterior column.

• #60 Hip Dysplasia | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/hip-dysplasia

  Periacetabular osteotomy (PAO) is the main surgical treatment for adolescents and young adults with hip dysplasia. PAO may serve as a lifelong treatment if performed before serious damage occurs within the joint. […] Your child’s treatment will depend on the severity of their condition. The goal of treatment is to restore normal hip function by correcting the position or structure of the joint. […] If your child’s hip continues to be partially or completely dislocated despite the use of the Pavlik harness and bracing, they may need surgery. […] If a closed reduction does not work, your child’s doctor may recommend open-reduction surgery.

• #61 Adolescent Hip Dysplasia – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/adolescent-hip-dysplasia/

  Treatment for adolescent hip dysplasia focuses on relieving pain while preserving the patient’s natural hip joint for as long as possible. […] Treatment for adolescent hip dysplasia focuses on delaying or preventing the onset of osteoarthritis while preserving the natural hip joint for as many years as possible. […] Your child’s doctor may recommend nonsurgical treatment if your child has mild hip dysplasia and no damage to the labrum or articular cartilage. […] Common nonsurgical treatments for adolescent hip dysplasia include: Observation. If your child has minimal symptoms and mild dysplasia, the doctor may recommend simply monitoring the condition to make sure it does not get worse. […] Your child’s doctor may recommend surgery if your child is experiencing pain and has limited damage to the articular cartilage in their hip.

• #62 Hip Dysplasia | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/hip-dysplasia

  Periacetabular osteotomy (PAO) is the main surgical treatment for adolescents and young adults with hip dysplasia. PAO may serve as a lifelong treatment if performed before serious damage occurs within the joint. […] Your child’s treatment will depend on the severity of their condition. The goal of treatment is to restore normal hip function by correcting the position or structure of the joint. […] If your child’s hip continues to be partially or completely dislocated despite the use of the Pavlik harness and bracing, they may need surgery. […] If a closed reduction does not work, your child’s doctor may recommend open-reduction surgery.

• #63 Adolescent Hip Dysplasia – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/adolescent-hip-dysplasia/

  The surgical procedure most commonly used to treat hip dysplasia is an osteotomy or „cutting of the bone.” […] Currently, the osteotomy procedure most commonly used to treat adolescent hip dysplasia is a periacetabular osteotomy (PAO). […] In conjunction with PAO, your child’s surgeon may use hip arthroscopy to repair a torn labrum. […] As with any surgical procedure, there are risks involved with PAO. […] Your child will remain in the hospital for 2 to 4 days after surgery. […] Periacetabular osteotomy is usually successful in delaying the need for an artificial hip joint and relieving pain.

• #64 Surgery for Developmental Hip Dysplasia | NYU Langone Health

  https://nyulangone.org/conditions/developmental-hip-dysplasia/treatments/surgery-for-developmental-hip-dysplasia

  Hip arthroscopy is a minimally invasive procedure that is often performed to repair torn cartilagea common complication of untreated developmental hip dysplasia in adults. […] Osteotomy is a type of surgery that may be used to deepen the hip socket and realign the thigh bone. […] A procedure known as a periacetabular, or Ganz, osteotomy is the most common and effective surgery for adolescents and adults with developmental hip dysplasia. […] Hip replacement surgery is a treatment of last resort that may be recommended for adults when developmental hip dysplasia cannot be effectively treated with hip-preserving techniques. […] Our doctors may prescribe medications and physical therapy to relieve pain and to help you regain mobility and strength after surgery.

• #65 Adolescent Hip Dysplasia – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/adolescent-hip-dysplasia/

  The surgical procedure most commonly used to treat hip dysplasia is an osteotomy or „cutting of the bone.” […] Currently, the osteotomy procedure most commonly used to treat adolescent hip dysplasia is a periacetabular osteotomy (PAO). […] In conjunction with PAO, your child’s surgeon may use hip arthroscopy to repair a torn labrum. […] As with any surgical procedure, there are risks involved with PAO. […] Your child will remain in the hospital for 2 to 4 days after surgery. […] Periacetabular osteotomy is usually successful in delaying the need for an artificial hip joint and relieving pain.

• #66

  https://www.parkwayeast.com.sg/conditions-diseases/developmental-hip-dysplasia/diagnosis-treatment

  How is hip dysplasia treated? […] If your baby is younger than 6 months, your doctor may use a soft brace, such as a Pavlik harness, to hold the ball portion of the joint firmly in its socket for several months. This helps to mould the socket to the shape of the ball. […] Your doctor may move the bones into the proper position and hold them there for several months with a full-body cast. Sometimes, surgery may be needed to fit the joint together properly. […] Treatment includes the following: […] For borderline hip dysplasia with labral tear, treatment is arthroscopic hip surgery. […] For severe hip dysplasia, a hip osteotomy is performed, where an orthopaedic surgeon reorientates the acetabulum and/or the femur to allow more normal acetabular coverage of the femoral head. In adults, the most common of this is a periacetabular osteotomy. […] For dysplasia with secondary hip osteoarthritis (severe damage to the hip joint cartilage), a total hip replacement is performed.

• #67 Hip Dysplasia: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17903-hip-dysplasia

  How is hip dysplasia treated? […] A healthcare provider will suggest treatments for hip dysplasia that relieve pain and protect your hip joint. The most common hip dysplasia treatments include: […] Wearing a brace: Babies may need to wear a brace or harness that holds their hips in place. This will keep their joints in proper alignment while their body grows and develops. Bracing is usually all your child will need to correct dysplasia, especially if they start treatment when theyre younger than 6 months old. Most babies need to wear a brace for a few months. […] Physical therapy: A physical therapist will give you stretches and exercises to strengthen the muscles around your hip joint and improve your flexibility. […] Hip dysplasia surgery: Your provider may recommend surgery to correct hip dysplasia if other treatments dont work. The most common procedures to repair hip dysplasia are hip osteotomy and hip arthroscopies. Osteotomy is surgery to realign and reshape your bones. A hip arthroscopy is a minimally invasive technique to repair damage inside your hip joint. People with severe hip dysplasia and arthritis might need a hip replacement (arthroplasty). Your surgeon will tell you which type of surgery you (or your child) will need and what to expect.

• #68 Surgery for Developmental Hip Dysplasia | NYU Langone Health

  https://nyulangone.org/conditions/developmental-hip-dysplasia/treatments/surgery-for-developmental-hip-dysplasia

  Hip arthroscopy is a minimally invasive procedure that is often performed to repair torn cartilagea common complication of untreated developmental hip dysplasia in adults. […] Osteotomy is a type of surgery that may be used to deepen the hip socket and realign the thigh bone. […] A procedure known as a periacetabular, or Ganz, osteotomy is the most common and effective surgery for adolescents and adults with developmental hip dysplasia. […] Hip replacement surgery is a treatment of last resort that may be recommended for adults when developmental hip dysplasia cannot be effectively treated with hip-preserving techniques. […] Our doctors may prescribe medications and physical therapy to relieve pain and to help you regain mobility and strength after surgery.

• #69

  https://www.parkwayeast.com.sg/conditions-diseases/developmental-hip-dysplasia/diagnosis-treatment

  How is hip dysplasia treated? […] If your baby is younger than 6 months, your doctor may use a soft brace, such as a Pavlik harness, to hold the ball portion of the joint firmly in its socket for several months. This helps to mould the socket to the shape of the ball. […] Your doctor may move the bones into the proper position and hold them there for several months with a full-body cast. Sometimes, surgery may be needed to fit the joint together properly. […] Treatment includes the following: […] For borderline hip dysplasia with labral tear, treatment is arthroscopic hip surgery. […] For severe hip dysplasia, a hip osteotomy is performed, where an orthopaedic surgeon reorientates the acetabulum and/or the femur to allow more normal acetabular coverage of the femoral head. In adults, the most common of this is a periacetabular osteotomy. […] For dysplasia with secondary hip osteoarthritis (severe damage to the hip joint cartilage), a total hip replacement is performed.

• #70 Dysplasia of the Hip (DDH) – Children’s Hospital of Orange County

  https://choc.org/orthopaedics/hip-program/ddh/

  For adolescents, treatments include: […] Physical therapy, activity restriction and weight loss. […] For adolescents who have pain and have limited damage to their cartilage, we may perform a Ganz periacetabular osteotomy (PAO). This procedure involves a series of cuts to the bone to move the socket over the thigh bone head. Screws are then placed in the bones to stabilize this position. […] In rare cases, we may also perform a femoral osteotomy or triple pelvic osteotomy. An osteotomy is a surgical procedure to reshape the bone and reduce stress on the area. […] A total joint replacement (arthroplasty) removes and replaces the damaged joint with an artificial joint and may be considered only after other treatment options have failed. […] For many adolescents, surgery allows them to return to normal activities after a recovery period. […] While these treatments are proven to be successful, any patient with hip dysplasia may develop deformity of the hip or osteoarthritis later in life.

• #71 Developmental Dysplasia of the Hip: Modern Approaches to Diagnosis and Treatment | Minnesota Chapter of the American Academy of Pediatrics

  https://wp.mnaap.org/developmental-dysplasia-of-the-hip-modern-approaches-to-diagnosis-and-treatment/

  For clinically unstable or dislocated hips, the optimal initiation of treatment with the Pavlik harness is as early as possible which is successful in over 85 percent of the patients. […] If bracing fails, then a closed reduction and spica cast application is performed around 6 months of age. […] Some dislocated hips require a more invasive surgery to open the hip joint and reduce the hip. […] Older children should also be treated if they develop symptoms. […] Children over age 10-12 can be treated with a periacetabular osteotomy, which is technically demanding but leads to powerful deformity correction. […] This combination of procedures has shown to decrease the rate of degenerative changes and delay hip replacement. […] Finally, if the DDH is not reconstructible, a hip replacement in late adulthood when performed by a high-volume academic center can return function to a painful hip. […] In conclusion, DDH is a common condition with reliable nonoperative treatment options if detected early. Surgery is required for older patients with a dislocated or unstable hip.

• #72 Hip Dysplasia: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17903-hip-dysplasia

  How is hip dysplasia treated? […] A healthcare provider will suggest treatments for hip dysplasia that relieve pain and protect your hip joint. The most common hip dysplasia treatments include: […] Wearing a brace: Babies may need to wear a brace or harness that holds their hips in place. This will keep their joints in proper alignment while their body grows and develops. Bracing is usually all your child will need to correct dysplasia, especially if they start treatment when theyre younger than 6 months old. Most babies need to wear a brace for a few months. […] Physical therapy: A physical therapist will give you stretches and exercises to strengthen the muscles around your hip joint and improve your flexibility. […] Hip dysplasia surgery: Your provider may recommend surgery to correct hip dysplasia if other treatments dont work. The most common procedures to repair hip dysplasia are hip osteotomy and hip arthroscopies. Osteotomy is surgery to realign and reshape your bones. A hip arthroscopy is a minimally invasive technique to repair damage inside your hip joint. People with severe hip dysplasia and arthritis might need a hip replacement (arthroplasty). Your surgeon will tell you which type of surgery you (or your child) will need and what to expect.

• #73 Rehabilitation for Hip Dysplasia | Med Diagnostics Rehab

  https://www.meddiagnosticrehab.co/rehabilitation-for-hip-dysplasia.php

  Rehabilitation for hip dysplasia, or developmental dislocation of the hip (DDH), is sometimes a treatment to remedy the condition itself and sometimes a treatment after surgery. […] It is extremely important that hip dysplasia be diagnosed and treated as early as possible because left untreated it results in severe osteoarthritis later in life. […] For very mild cases of dysplasia in children, physical therapy can be beneficial in promoting hip function, strengthening the joint and maximizing the patient’s range of motion. […] In the case of newborns and very young children, whose bones are more malleable, nonsurgical braces and casts can make all the difference. […] Although these devices limit mobility for several months, they move the hip into proper alignment, almost always correcting the condition permanently.

• #74 Rehabilitation for Hip Dysplasia | Med Diagnostics Rehab

  https://www.meddiagnosticrehab.co/rehabilitation-for-hip-dysplasia.php

  Rehabilitation for hip dysplasia, or developmental dislocation of the hip (DDH), is sometimes a treatment to remedy the condition itself and sometimes a treatment after surgery. […] It is extremely important that hip dysplasia be diagnosed and treated as early as possible because left untreated it results in severe osteoarthritis later in life. […] For very mild cases of dysplasia in children, physical therapy can be beneficial in promoting hip function, strengthening the joint and maximizing the patient’s range of motion. […] In the case of newborns and very young children, whose bones are more malleable, nonsurgical braces and casts can make all the difference. […] Although these devices limit mobility for several months, they move the hip into proper alignment, almost always correcting the condition permanently.

• #75 Hip Dysplasia – In Motion O.C.

  https://www.inmotionoc.com/ailments/hip/hip-dysplasia/

  In some mold cases, including some physical therapy hip dysplasia exercises into your lifestyle can be a helpful option to help lubricate the joint and ease mobility. […] Physical therapy is a great option for hip dysplasia patients to help strengthen muscles surrounding the hip, joint mobility, correct poor posture, tendon inflammation, gait, and body awareness. […] Medical professionals also may recommend including low- or non-impact exercises into your weekly routine to strengthen muscles and increase range of motion. […] Many exercises and stretches can help relieve pain from hip dysplasia and work to strengthen the muscles surrounding the hip, and working with a trusted physical therapist can be helpful in getting the proper treatment.

• #76 Hip Dysplasia in Adults | Med Diagnostics Rehab

  https://www.meddiagnosticrehab.co/hip-dysplasia-in-adults.php

  Depending on the severity of the dysplasia and the seriousness of the symptoms, the treatment may vary. […] For mild cases, physical therapy may be sufficient to lubricate the joint, lessen pain, and ease mobility. Physical therapy includes leg stretching, particularly hip abductions, during which the leg is moved out from the body. […] When the arthritis in the hip is more advanced and the pain more intrusive, hip arthroplasty, commonly known as hip replacement surgery, is necessary.

• #77 Adolescent Acetabular Dysplasia (Idiopathic DDH) | Pediatric Orthopaedic Society of North America (POSNA)

  https://posna.org/physician-education/study-guide/adolescent-acetabular-dysplasia-(idiopathic-ddh)

  Periacetabular osteotomy is an effective treatment that can alter the natural history of dysplastic hips. […] The mainstay of treatment for hip instability secondary to acetabular dysplasia in the skeletally mature patient is the periacetabular osteotomy, as developed by Ganz. […] There is evidence that treatment of severe acetabular dysplasia (LCE 15) in hips with intact articular cartilage with acetabular reorientation can affect the natural history of hip dysplasia and prolong the longevity of the native hip. […] The first line treatment of acetabular dysplasia in moderate and mild cases is physical therapy, consisting of core, back and hip strengthening. […] Hip injections can be helpful for symptoms relating to labral pathology, but do not address underlying bony deficiencies.

• #78 Hip Dysplasia – In Motion O.C.

  https://www.inmotionoc.com/ailments/hip/hip-dysplasia/

  In some mold cases, including some physical therapy hip dysplasia exercises into your lifestyle can be a helpful option to help lubricate the joint and ease mobility. […] Physical therapy is a great option for hip dysplasia patients to help strengthen muscles surrounding the hip, joint mobility, correct poor posture, tendon inflammation, gait, and body awareness. […] Medical professionals also may recommend including low- or non-impact exercises into your weekly routine to strengthen muscles and increase range of motion. […] Many exercises and stretches can help relieve pain from hip dysplasia and work to strengthen the muscles surrounding the hip, and working with a trusted physical therapist can be helpful in getting the proper treatment.

• #79 Surgery for Developmental Hip Dysplasia | NYU Langone Health

  https://nyulangone.org/conditions/developmental-hip-dysplasia/treatments/surgery-for-developmental-hip-dysplasia

  Hip arthroscopy is a minimally invasive procedure that is often performed to repair torn cartilagea common complication of untreated developmental hip dysplasia in adults. […] Osteotomy is a type of surgery that may be used to deepen the hip socket and realign the thigh bone. […] A procedure known as a periacetabular, or Ganz, osteotomy is the most common and effective surgery for adolescents and adults with developmental hip dysplasia. […] Hip replacement surgery is a treatment of last resort that may be recommended for adults when developmental hip dysplasia cannot be effectively treated with hip-preserving techniques. […] Our doctors may prescribe medications and physical therapy to relieve pain and to help you regain mobility and strength after surgery.

• #80 Rehabilitation for Hip Dysplasia | Med Diagnostics Rehab

  https://www.meddiagnosticrehab.co/rehabilitation-for-hip-dysplasia.php

  The younger the child at the time of surgery, the greater the chance for a successful outcome. […] For mild cases, physical therapy may be sufficient to lubricate the joint, lessen pain, and ease mobility. […] When the arthritis in the hip is more advanced, hip arthroplasty, commonly known as hip replacement surgery, is necessary. […] Physical therapy includes leg stretching, particularly hip abductions, during which the leg is moved out from the body. […] Physical therapy begins as soon as possible after the procedure, often the very next day. […] Most patients go home within a week after hip surgery, but need to continue outpatient rehabilitation from home. […] The goal of rehabilitation is to strengthen the affected muscles and to prevent excessive scarring and contracture. […] Physical therapy exercises begin with the patient seated and progress to walking and climbing stairs, first with, and then without, supportive devices.

• #81 Rehabilitation for Hip Dysplasia | Med Diagnostics Rehab

  https://www.meddiagnosticrehab.co/rehabilitation-for-hip-dysplasia.php

  The younger the child at the time of surgery, the greater the chance for a successful outcome. […] For mild cases, physical therapy may be sufficient to lubricate the joint, lessen pain, and ease mobility. […] When the arthritis in the hip is more advanced, hip arthroplasty, commonly known as hip replacement surgery, is necessary. […] Physical therapy includes leg stretching, particularly hip abductions, during which the leg is moved out from the body. […] Physical therapy begins as soon as possible after the procedure, often the very next day. […] Most patients go home within a week after hip surgery, but need to continue outpatient rehabilitation from home. […] The goal of rehabilitation is to strengthen the affected muscles and to prevent excessive scarring and contracture. […] Physical therapy exercises begin with the patient seated and progress to walking and climbing stairs, first with, and then without, supportive devices.

• #82 Rehabilitation for Hip Dysplasia | Med Diagnostics Rehab

  https://www.meddiagnosticrehab.co/rehabilitation-for-hip-dysplasia.php

  Rehabilitation includes occupational therapy and at-home exercises to help patients learn new ways to function effectively in everyday activities. […] The length of short-term recovery, when a patient is able to be walk unassisted and perform most household tasks, and long-term recovery, when a patient is fully independent, may vary quite considerably from 6 weeks to 6 months.

• #83 Rehabilitation for Hip Dysplasia | Med Diagnostics Rehab

  https://www.meddiagnosticrehab.co/rehabilitation-for-hip-dysplasia.php

  The younger the child at the time of surgery, the greater the chance for a successful outcome. […] For mild cases, physical therapy may be sufficient to lubricate the joint, lessen pain, and ease mobility. […] When the arthritis in the hip is more advanced, hip arthroplasty, commonly known as hip replacement surgery, is necessary. […] Physical therapy includes leg stretching, particularly hip abductions, during which the leg is moved out from the body. […] Physical therapy begins as soon as possible after the procedure, often the very next day. […] Most patients go home within a week after hip surgery, but need to continue outpatient rehabilitation from home. […] The goal of rehabilitation is to strengthen the affected muscles and to prevent excessive scarring and contracture. […] Physical therapy exercises begin with the patient seated and progress to walking and climbing stairs, first with, and then without, supportive devices.

• #84 Rehabilitation for Hip Dysplasia | Med Diagnostics Rehab

  https://www.meddiagnosticrehab.co/rehabilitation-for-hip-dysplasia.php

  Rehabilitation includes occupational therapy and at-home exercises to help patients learn new ways to function effectively in everyday activities. […] The length of short-term recovery, when a patient is able to be walk unassisted and perform most household tasks, and long-term recovery, when a patient is fully independent, may vary quite considerably from 6 weeks to 6 months.

• #85 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  Reduction of the hip should be confirmed by ultrasonography within three weeks of harness placement. […] The long-term results of Pavlik harness treatment (e.g., nonoperative treatment) show a 95 percent success rate for acetabular dysplasia and subluxation. […] In children older than six months, closed reduction under general anesthesia and hip spica casting is the treatment of choice. […] If the hip is irreducible by closed means, or a concentric reduction is not achieved, successful treatment requires open reduction. […] The goal of operative treatment of DDH is to normalize the hip joint to delay or prevent the premature onset of osteoarthritis. […] A child with DDH usually requires long-term follow-up with radiographic evaluation until skeletal maturity is reached to ensure normal hip development. […] In general, the goal of the family physician in examining for DDH should be early diagnosis and referral.

• #86 Developmental dysplasia of the hip (DDH) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/developmental-dysplasia-hip-ddh

  If a closed reduction is not successful, the next line of treatment is surgery in the form of an open reduction, to reposition the ball within the socket. […] This involves an incision, opening of the hip joint itself, and directly visualizing the ball and socket. After open reduction infants will require a spica cast but generally for less time than after a closed reduction. […] Newborn screening for congenital hip dysplasia has allowed for earlier detection of this hip condition. If identified early, treatment generally entails a harness or brace and is quite successful. The older a child presents, the more likely that surgery will be necessary. […] Continued follow-up even after successful treatment of hip dysplasia in an infant is very important because as a child grows into an adolescent the socket needs to be monitored to be sure that it, too, is developing properly. Occasionally, additional surgeries will be needed to help deepen a socket and minimize the risk of arthritis as an adult.

• #87 Hip Dysplasia

  https://www.massgeneral.org/orthopaedics/children/conditions-and-treatments/hip-dysplasia

  Developmental dysplasia of the hip (DDH) may occur during fetal development, at delivery, or after birth. […] Once the diagnosis of DDH has been made, the treatment will depend on the age of the child and the degree of instability. […] If the ultrasound shows that the hip is subluxating, dislocated, or that the acetabulum is shallow (decreased femoral head coverage), the initial treatment may consist of a Pavlik harness. […] The Pavlik harness is often used as the initial treatment of hip dysplasia in infants. […] The Pavlik harness is successful in approximately 90-95% of infants with hip dysplasia. […] If there is no improvement in the hip dysplasia with the Pavlik harness, the baby will most likely require a closed reduction and spica casting in the operating room. […] If the hip dysplasia cannot be corrected with the Pavlik harness or closed reduction and casting, it may be necessary to proceed with open reduction and spica casting. […] The older the infant or child is at the time of diagnosis, the more likely he/she will require operative intervention to correct the dysplasia. […] Generally follow-up appointments occur at 6 months, 12 months, 2 years and 4-5 years.

• #88 Developmental Dysplasia of the Hip (DDH)

  https://patient.info/doctor/developmental-dysplasia-of-the-hip-pro

  Surgery is indicated for those who do not respond to early splint or harness treatment and for those who are diagnosed late and are not suitable for splint or harness treatment. […] […] The most common operation is closed reduction with adductor or psoas tenotomy (to decrease adduction contracture), followed by 3-4 months in a plaster cast or abduction brace. […] […] The older the child, the more likely an extensive procedure will be required with open reduction and soft tissue stabilisation of the joint, followed by a cast. […] […] Over the age of 18-24 months, an additional pelvic and/or femoral osteotomy is often required. […] […] Results worsen the older the child is at the time of surgery. Osteonecrosis and re-dislocation predict a poor functional result. A child aged over 3, with highly dysplastic acetabula, may have a better outcome if left untreated, as they may not have sufficient acetabular growth to remodel a surgically reduced hip. […] […] Follow-up is required at least until the hip is clinically stable and imaging shows a stable, centred, normal hip. […] […] The length of follow-up and the frequency of radiographic examinations are still debated. […] […] Follow-up may reveal acetabular dysplasia in the contralateral hip.

• #89 Developmental Dysplasia of the Hip (DDH)

  https://patient.info/doctor/developmental-dysplasia-of-the-hip-pro

  Surgery is indicated for those who do not respond to early splint or harness treatment and for those who are diagnosed late and are not suitable for splint or harness treatment. […] […] The most common operation is closed reduction with adductor or psoas tenotomy (to decrease adduction contracture), followed by 3-4 months in a plaster cast or abduction brace. […] […] The older the child, the more likely an extensive procedure will be required with open reduction and soft tissue stabilisation of the joint, followed by a cast. […] […] Over the age of 18-24 months, an additional pelvic and/or femoral osteotomy is often required. […] […] Results worsen the older the child is at the time of surgery. Osteonecrosis and re-dislocation predict a poor functional result. A child aged over 3, with highly dysplastic acetabula, may have a better outcome if left untreated, as they may not have sufficient acetabular growth to remodel a surgically reduced hip. […] […] Follow-up is required at least until the hip is clinically stable and imaging shows a stable, centred, normal hip. […] […] The length of follow-up and the frequency of radiographic examinations are still debated. […] […] Follow-up may reveal acetabular dysplasia in the contralateral hip.

• #90 Developmental Dysplasia of the Hip (DDH)

  https://patient.info/doctor/developmental-dysplasia-of-the-hip-pro

  Surgery is indicated for those who do not respond to early splint or harness treatment and for those who are diagnosed late and are not suitable for splint or harness treatment. […] […] The most common operation is closed reduction with adductor or psoas tenotomy (to decrease adduction contracture), followed by 3-4 months in a plaster cast or abduction brace. […] […] The older the child, the more likely an extensive procedure will be required with open reduction and soft tissue stabilisation of the joint, followed by a cast. […] […] Over the age of 18-24 months, an additional pelvic and/or femoral osteotomy is often required. […] […] Results worsen the older the child is at the time of surgery. Osteonecrosis and re-dislocation predict a poor functional result. A child aged over 3, with highly dysplastic acetabula, may have a better outcome if left untreated, as they may not have sufficient acetabular growth to remodel a surgically reduced hip. […] […] Follow-up is required at least until the hip is clinically stable and imaging shows a stable, centred, normal hip. […] […] The length of follow-up and the frequency of radiographic examinations are still debated. […] […] Follow-up may reveal acetabular dysplasia in the contralateral hip.

• #91 Developmental Dysplasia of the Hip (DDH) – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/developmental-dislocation-dysplasia-of-the-hip-ddh/

  In many children with DDH, a body cast and/or brace is required to keep the hip bone in the joint during healing. The cast may be needed for 2 to 3 months. Your child’s doctor may change the cast during this time period. […] If diagnosed early and treated successfully, children are able to develop a normal hip joint and should have no limitation in function. Left untreated, DDH can lead to pain and osteoarthritis by early adulthood. It may produce a difference in leg length or decreased agility. […] Even with appropriate treatment, hip deformity and osteoarthritis may develop later in life. This is especially true when treatment begins after the age of 2.

• #92 Dysplasia of the Hip (DDH) – Children’s Hospital of Orange County

  https://choc.org/orthopaedics/hip-program/ddh/

  For adolescents, treatments include: […] Physical therapy, activity restriction and weight loss. […] For adolescents who have pain and have limited damage to their cartilage, we may perform a Ganz periacetabular osteotomy (PAO). This procedure involves a series of cuts to the bone to move the socket over the thigh bone head. Screws are then placed in the bones to stabilize this position. […] In rare cases, we may also perform a femoral osteotomy or triple pelvic osteotomy. An osteotomy is a surgical procedure to reshape the bone and reduce stress on the area. […] A total joint replacement (arthroplasty) removes and replaces the damaged joint with an artificial joint and may be considered only after other treatment options have failed. […] For many adolescents, surgery allows them to return to normal activities after a recovery period. […] While these treatments are proven to be successful, any patient with hip dysplasia may develop deformity of the hip or osteoarthritis later in life.

• #93 Developmental Dysplasia of the Hip (DDH) – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/developmental-dislocation-dysplasia-of-the-hip-ddh/

  In many children with DDH, a body cast and/or brace is required to keep the hip bone in the joint during healing. The cast may be needed for 2 to 3 months. Your child’s doctor may change the cast during this time period. […] If diagnosed early and treated successfully, children are able to develop a normal hip joint and should have no limitation in function. Left untreated, DDH can lead to pain and osteoarthritis by early adulthood. It may produce a difference in leg length or decreased agility. […] Even with appropriate treatment, hip deformity and osteoarthritis may develop later in life. This is especially true when treatment begins after the age of 2.

• #94 Developmental dysplasia of the hip (DDH)

  https://www.rch.org.au/kidsinfo/fact_sheets/Developmental_dysplasia_of_the_hip_DDH/

  Treatment may include a brace, a plaster cast called a hip spica, movement of the hip into position under anaesthetic, or surgery to the ligaments around the joint. […] Children will often need to wear a brace or cast for several months. […] If DDH is not treated, your child may develop a painless limp. Over time, painful arthritis will develop in the untreated hip joint.

• #95 Hip Dysplasia in Children: Causes, Symptoms and Treatment

  https://www.nationwidechildrens.org/family-resources-education/700childrens/2017/08/hip-dysplasia-in-children-causes-symptoms-and-treatment

  If DDH is detected, your child will be referred to a pediatric orthopedist for treatment. As DDH presents differently for every child, treatment looks different as well. Stable hips that become normal do not need treatment. However, close follow-up and routine exams are required through the child’s development. If unstable, your orthopedist can offer treatment options with the goal of putting and keeping the head of the femur back into the hip socket so that the hip can develop. Treatment may include a special device or Pavlik harness to hold the hip in place or casting. Some babies may need surgery to realign the hip. […] Early diagnosis and treatment for DDH is crucial to a child’s development down the road. Many children treated within the first six months recover and develop normally with no long-term problems. However, the older the child or less successful the repositioning, the greater the possibility is for future problems including early onset degenerative hip disease, arthritis and pain in older patients if treatment is foregone.

• #96 Developmental Dysplasia of the Hip | Loma Linda University Children’s Health

  https://lluch.org/conditions/developmental-dysplasia-of-hip

  Surgery. If the other methods dont work, or if DDH is diagnosed at age 6 months to 2 years, your child may need surgery to realign the hip. Your child may then have to wear a spica cast for up to 6 months after surgery. This special cast holds the hip in place as it heals. After the cast is removed, your child may need a special brace or physical therapy exercises to strengthen the muscles around the hip and in the legs. […] Treatment may include a Pavlik harness, casting, or surgery.

• #97 Developmental Dysplasia of the Hip (DDH): Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1248135-overview

  Early diagnosis is the most crucial aspect of the treatment of children with DDH. […] Newer, less invasive surgical techniques (eg, endoscopic techniques and image-guided surgery) are being developed in an effort to decrease the morbidity of surgery and to ease recovery. […] Overall, the prognosis for children treated for hip dysplasia is very good, especially if the dysplasia is managed with closed treatment. If closed treatment is unsuccessful and open reduction is needed, the outcome may be less favorable, although the short-term outcome appears to be satisfactory. […] If secondary procedures are needed to obtain reduction, then the overall outcome is significantly worse. […] It has been argued that patients with bilateral hip dysplasia have a poorer prognosis because of frequent delays in diagnosis and greater treatment requirements.

• #98 Treatment of bilateral developmental dysplasia of the hip joint with an improved technique: A case report

  https://www.wjgnet.com/2307-8960/full/v12/i7/1320.htm

  Treatment of bilateral developmental dysplasia of the hip joint with an improved technique: A case report. Developmental dysplasia of the hip (DDH) is a common osteoarticular deformity in pediatric orthopedics. A patient with bilateral DDH was diagnosed and treated using our improved technique „(powerful overturning acetabuloplasty)” combined with femoral rotational shortening osteotomy. Our „powerful overturning acetabuloplasty” combined with femoral rotational shortening osteotomy is feasible in the treatment of DDH in children. This technology may be widely used in the clinic. On the basis of traditional acetabular capping, we improved this method using „powerful overturning acetabuloplasty”, and combined this technique with a femoral rotation shortening osteotomy to treat a 4-year-old child. The function of both lower limbs recovered well after surgery, and no complications were observed during follow-up. A Smith-Peterson incision was performed, the sartorius muscle, tensor fascia lata muscle, and rectus femoris were completely released, and the straight head, inverted head, gluteus medius muscle, and gluteus minimus of the rectus femoris, as well as the iliopsoas muscle which pressed on the front side of the primary acetabulum entrance, were cut. Our improved „powerful overturning acetabuloplasty” strengthened the coverage of the acetabulum on the femoral head. It is feasible to treat pediatric DDH by simultaneous open reduction and „powerful overturning acetabuloplasty” combined with femoral rotational shortening osteotomy without complications.

• #99 A comprehensive nonoperative treatment protocol for developmental dysplasia of the hip in infants | Bone & Joint

  https://boneandjoint.org.uk/Article/10.1302/0301-620X.105B8.BJJ-2023-0149.R1

  Optimizing the nonoperative treatment strategy of infant DDH is important to improve outcomes, minimize complications, and reduce the need for surgical intervention. […] Standardized treatment protocols have been shown to dramatically improve outcomes and efficiency in DDH management. […] Our results have shown high rates of initial treatment success and extremely low rates of residual dysplasia at a mean of five years in a prospective longitudinal cohort of infants treated for DDH using a comprehensive nonoperative protocol.

• #100 A comprehensive nonoperative treatment protocol for developmental dysplasia of the hip in infants | Bone & Joint

  https://boneandjoint.org.uk/Article/10.1302/0301-620X.105B8.BJJ-2023-0149.R1

  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. […] 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. […] Our study addresses the gap in evidence-based treatment protocols for the brace treatment of infant developmental dysplasia of the hip (DDH). […] This reproducible evidence-based treatment protocol can be used to help standardize care, improve outcomes, and reduce unnecessary surgery, and can be used as a baseline for future treatment comparisons. […] Early diagnosis of DDH and nonoperative management with a brace is the most effective overall strategy.

• #101

  https://journals.lww.com/md-journal/fulltext/2024/03150/the_outcome_of_early_screening_and_treatment_of.10.aspx

  This study is an observation of the early screening and treatment effect of infant developmental dysplasia of the hip (DDH) in an area in China. […] Early and individualized corrective conservative treatment was considered for children with abnormalities, and the cure rates were 87.0%, 65.7%, 41.0%, and 16.7% among those with 0 to 6 months, 7 to 12 months, 13 to 18 months, and 19 to 24 months of age, respectively. […] Early active and individualized treatment and regular follow-ups were considered for children diagnosed with DDH. […] For children with DDH under 6 months of age, Pavlik harness or bilateral hip abduction brace was used for treatment. […] For children with DDH over 6 months old, individualized corrective treatment was used according to the diagnostic classification. […] Clinical cure was considered if the acetabular head was repositioned and the acetabular index decreased to normal.

• #102 Developmental dysplasia of the hip – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/developmental-dysplasia-of-the-hip/

  The goals of treatment are to reduce the femoral head into the acetabulum as early as possible to allow normal development of the hip joint. An abduction brace is used for infants of age, while surgical repair is typically recommended for those 6 months of age. […] Treatment is determined by a pediatric orthopedic specialist and is based on patient age and severity. […] Abduction bracing: Indication: of age. Mechanism: positional reduction of the affected femoral head by keeping the hips in flexed abduction. Options: static rigid splint; (e.g., von Rosen harness; ) or dynamic soft splint (e.g., Pavlik harness). […] Surgical repair: Indications: 6 months of age or unsuccessful abduction bracing. Mechanism: Surgical reduction or, in arthroplasty, replacement of the affected femoral head. In children: subsequent immobilization in a hip spica cast. Options: Infants 6-11 months of age: closed reduction; Children 12-18 months of age: open reduction; Individuals 18 months of age: open reduction pelvic and/or femoral osteotomy; Older adolescents or adults: total hip arthroplasty.

• #103 Developmental Dysplasia of the Hip (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/ddh.html

  Most infants treated for DDH develop into active, healthy kids and have no hip problems. […] A pediatric orthopedic surgeon (a specialist in children’s bone conditions) cares for babies and kids with DDH. The goal of care is to get the ball of the hip in the socket and keep it there, so the joint can grow normally. […] The orthopedic surgeon chooses the treatment based on the child’s age. Options include: bracing, a closed reduction and casting, an open reduction (surgery) and casting. […] Treatment for babies younger than 6 months old usually is a brace. The brace used most often is a Pavlik harness. It has a shoulder harness that attaches to foot stirrups. It puts the baby’s legs into a position that guides the ball of the hip joint into the socket. […] Treatment with the Pavlik harness often lasts about 612 weeks. While wearing the harness, the baby has a checkup every 13 weeks with hip ultrasounds and exams. During the visit, the medical team can adjust the harness if needed.

• #104 Hip Dysplasia (DDH): Symptoms, Testing and Treatment

  https://www.nationwidechildrens.org/conditions/hip-dysplasia

  Once DDH is identified, prompt referral to a pediatric orthopedist is suggested. […] With an unstable, Ortolani positive hip, early treatment is required. Reduced hips are positioned in flexion and mild abduction to stimulate normal joint development, most commonly performed via the Pavlik harness, a dynamic brace which positions the thighs to allow and maintain hip reduction. […] Treatment success depends on the child’s age and the success of repositioning. Many cases treated in the first 6 months of life with a Pavlik harness recover and develop normally with no long-term problems. The older the child or less successful the reduction, the greater the possible need for repeated surgeries or eventual hip arthritis and subsequent replacements later in life.

• #105 Developmental dysplasia of the hip Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/developmental-dysplasia-of-the-hip

  When the problem is found during the first 6 months of life, a device or harness is used to keep the legs apart and turned outward (frog-leg position). This device will most often hold the hip joint in place while the child grows. […] This harness works for most infants when it is started before age 6 months, but it is less likely to work for older children. […] Children who do not improve or who are diagnosed after 6 months often need surgery. After surgery, a cast will be placed on the child’s leg for a period of time. […] If hip dysplasia is found in the first few months of life, it can almost always be treated successfully with a positioning device (bracing). In a few cases, surgery is needed to put the hip back in joint. […] Hip dysplasia that is found after early infancy may lead to a worse outcome and may need more complex surgery to fix the problem.

• #106 Developmental Dysplasia of the Hip (DDH): Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1248135-overview

  Early diagnosis is the most crucial aspect of the treatment of children with DDH. […] Newer, less invasive surgical techniques (eg, endoscopic techniques and image-guided surgery) are being developed in an effort to decrease the morbidity of surgery and to ease recovery. […] Overall, the prognosis for children treated for hip dysplasia is very good, especially if the dysplasia is managed with closed treatment. If closed treatment is unsuccessful and open reduction is needed, the outcome may be less favorable, although the short-term outcome appears to be satisfactory. […] If secondary procedures are needed to obtain reduction, then the overall outcome is significantly worse. […] It has been argued that patients with bilateral hip dysplasia have a poorer prognosis because of frequent delays in diagnosis and greater treatment requirements.

• #107 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  Reduction of the hip should be confirmed by ultrasonography within three weeks of harness placement. […] The long-term results of Pavlik harness treatment (e.g., nonoperative treatment) show a 95 percent success rate for acetabular dysplasia and subluxation. […] In children older than six months, closed reduction under general anesthesia and hip spica casting is the treatment of choice. […] If the hip is irreducible by closed means, or a concentric reduction is not achieved, successful treatment requires open reduction. […] The goal of operative treatment of DDH is to normalize the hip joint to delay or prevent the premature onset of osteoarthritis. […] A child with DDH usually requires long-term follow-up with radiographic evaluation until skeletal maturity is reached to ensure normal hip development. […] In general, the goal of the family physician in examining for DDH should be early diagnosis and referral.

• #108 A comprehensive nonoperative treatment protocol for developmental dysplasia of the hip in infants | Bone & Joint

  https://boneandjoint.org.uk/Article/10.1302/0301-620X.105B8.BJJ-2023-0149.R1

  Optimizing the nonoperative treatment strategy of infant DDH is important to improve outcomes, minimize complications, and reduce the need for surgical intervention. […] Standardized treatment protocols have been shown to dramatically improve outcomes and efficiency in DDH management. […] Our results have shown high rates of initial treatment success and extremely low rates of residual dysplasia at a mean of five years in a prospective longitudinal cohort of infants treated for DDH using a comprehensive nonoperative protocol.

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