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

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-02-19 DOI:10.1016/j.jcot.2025.102944

Daniela Alessia Marletta , Biagio Zampogna , Gabriele Giuca , Matteo Nanni , Sanzarello Ilaria , Danilo Leonetti

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引用次数: 0

Abstract

Background

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

Methods

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

Results

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

Conclusion

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

Level of evidence

Level IV

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.