Active monitoring versus immediate abduction as treatment of stable developmental dysplasia of the hip: a systematic review of the literature

Abstract

ObjectivesThis systematic review aims to compare the effects of active monitoring and abduction treatment on the Graf alpha angle, Acetabular Index (AI) and femoral head coverage in infants with stable developmental dysplasia of the hip (DDH).DesignSystematic review reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesA search of the PubMed, Embase, Cochrane and Web of Science databases was performed in January 2020 and updated in January 2021.Eligibility criteria(Non-)randomised studies comparing active monitoring with abduction treatment in infants younger than 4 months with stable DDH were included.Data extraction and synthesisAll eligible articles were methodologically assessed using the Cochrane risk of bias tools. Data were extracted by summarising the study characteristics and results.ResultsOf the six included studies, two randomised studies were of low risk and two of some concerns. Two non-randomised studies were of serious risk. In total, 544 dysplastic hips (439 infants) were investigated, of which 307 were observed and 237 were treated. Two studies reported a faster improvement of the alpha angle and average acetabular coverage in treated hips at 3 months. No differences in AI between the treatment and observation group after 3 months were reported. In total, 38 infants (12%) in the observation group switched to the treatment group. At the final radiograph, 21 observed hips and 32 treated hips were dysplastic.ConclusionsThere were no differences in AI between the treatment and observation group after 3 months in infants up to 4 months of age with stable DDH hips. The switch of 38 infants (12%) from the observation to the treatment group corroborates that not all infantile DDH hips will spontaneously progress into normal hips. The small study population sizes and methodological heterogeneity warrant a large randomised controlled trial to study this research question.PROSPERO registration numberCRD4202123300.

Active monitoring versus an abduction device for treatment of infants with centered dysplastic hips: study protocol for a randomized controlled trial (TReatment with Active Monitoring (TRAM)-Trial)

“…A few studies have compared active monitoring and abduction treatment for infants with centered DDH [ 10 – 15 ]. A recent review summarizes that there is no difference in acetabular index between active monitoring and abduction treatment for infants up to four months of age with centered DDH after three months [ 16 ]. However, the included six studies showed considerable methodological heterogeneity and two non-randomized studies were rated as serious risk of bias.…”

Positive family history and girl sex might increase the risk of failure of abduction treatment in developmental dysplasia of the hip

“…[13][14][15] With mild DDH, previous studies suggest that observation period of four to six weeks is safe, as many of these children recover spontaneously 8,16 . It is also known that stable, but dysplastic hips do not require abduction treatment 17 . There are several studies around the subject of abduction treatment failure and some risk factors associated to treatment failure have been found.…”