Dynamic splinting without scheduled weaning led to greater early improvements in hip development compared with observation or double diapering in infants under 6 months with immature or dysplastic hips, according to new findings.
Researchers conducted a cohort study and a network meta-analysis (NMA) to compare early hip interventions among infants diagnosed with hip immaturity or developmental dysplasia. The cohort study included 103 hips, treated with the Pavlik harness (n = 35), double diapering (n = 39), or observation (n = 29). Outcomes were tracked over 12 months and included alpha angle improvement and femoral head coverage (FHC).
At 1 month, mean alpha angle improvement was greatest with the Pavlik harness (11°), followed by double diapering (9°) and observation (5°). FHC improved by 0.15 with the Pavlik harness, 0.08 with double diapering, and 0.05 with observation.
Odds of alpha angle normalization were higher with both the Pavlik harness and double diapering compared with observation at 1 month. By 3 months, hips had normalized across all groups.
In the NMA of 681 hips from nine studies, dynamic splinting without weaning was associated with greater alpha angle improvement than observation. Double diapering also outperformed observation. Normalization rates were higher with both dynamic splinting and double diapering.
Mongolian swaddling was linked with lower normalization and higher treatment switching rates.
Dynamic splinting had the lowest treatment switching rate, both with and without weaning. No statistically significant differences were observed in adverse events across groups.
“Our cohort study demonstrated that Pavlik harness was most effective in promoting early hip development, achieving superior improvements during the initial treatment phase compared to double diapering and observation,” wrote corresponding author Yu-Cheng Su from the Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
The study aimed to address the evidence gap in managing Graf type IIa hips. Researchers concluded that dynamic splinting accelerates hip normalization compared with observation, and that double diapering may serve as an effective, less restrictive alternative.
Full disclosures can be found in the published study.
Source: eClinical Medicine
