Treatment

• Pavlik harness (most commonly used splinting device) that maintains the hips in 90–100° of flexion and 50° of abduction [3]

• Alternatives: rigid harnesses (e.g., von Rosen harness)

  • A rigid harness that is used to treat infants with developmental dysplasia of the hip (DDH) below the age of 6 months.

  • The harness keeps the hips abducted by 50° and flexed by 90–100° in order to achieve concentric reduction of the femoral head.

6–18 months or failure of bracing: closed reduction followed by immobilization with a hip spica cast

• > 18 months or failure of closed reduction: surgical therapy (open reduction possibly with a pelvic/femoral osteotomy) followed by immobilization with a hip spica cast

• Older adolescents or adults: total hip arthroplasty

• Complications of DDH

  • Residual acetabular dysplasia, subluxation, and/or redislocation despite treatment

  • Early osteoarthritis in the hip joint

  • Leg length discrepancy which may present with back pain, functional scoliosis, and/or knee pain

  • Genu valgum

• Complications of treatment

  • Avascular necrosis (AVN) of the femoral epiphysis

  • Treatment-related transient femoral nerve palsy

  • Pavlik harness disease

• The outcomes of children with DDH who receive early treatment are generally good.

• The reappearance of a U shaped acetabular teardrop shadow (Köhler's shadow) after reduction is an indicator of good hip function.

• Factors associated with a poor prognosis

  • Late initiation of treatment (especially after 6 months)

  • Need for open reduction

  • Failure of a first-line treatment

  • Possibly, bilateral hip dislocation