Tübingen hip flexion splints for developmental dysplasia of the hip in infants aged 0–6 months

Abstract

Background: Developmental dysplasia of the hip (DDH) is a common disorder in infants. The present study aimed to evaluate the efficacy and safety of the Tübingen hip flexion splints in treating DDH in infants aged 0-6 months. Methods: This is a retrospective study analyzing 259 hips in 195 infants with DDH of Graf type IIc or worse classifications treated between January 2015 and December 2017. Patients were followed up for at least 6 months. Avascular necrosis of the femoral head was diagnosed using plain radiographs at the last follow-up visit according to the Bucholz-Ogden classification. Successful treatment was defined as an improvement of the Graft classification to type I, or an improvement of the International Hip Dysplasia Institute classification to type I in patients aged > 6 months. Results: Treatment was deemed successful in 128 patients (83.7%). Avascular necrosis occurred in 3 patients (3 hips). Univariate analysis showed that late treatment initiation, family history of DDH, Graf type IV and bilateral involvement were independent risk factors for treatment failure (p < 0.05). The receiver operating characteristic curve showed a cutoff value of 12 weeks for age at treatment initiation regarding successful treatment. Logistic regression analysis showed that gender, breech presentation, firstborn, swaddling, birth weight > 3.5 kg, oligohydramnios, foot deformity and torticollis did not affect the success rate of treatment (p > 0.05). Conclusions: The Tübingen splint showed good efficacy and safety in treating DDH in infants aged 0-6 months. Family history of DDH, Graf classification of type IV, bilateral involvement and treatment initiation after 12 weeks of age are risk factors of treatment failure. Trial registration: N/A

Tübingen hip flexion splint for the treatment of developmental dysplasia of the hip in children younger than six months age: A meta-analysis

“…Following screening on the pre-specified criteria, including full text review of retained abstracts, eight articles in English and one in German were included in our analysis. 13 , 14 , 19 - 25 Two of these articles, by Kubo et al 13 , 20 used the same study group with outcomes measured at the mid-term and end-point of the period of follow-up. The flow diagram of study selection is shown in Fig.…”

“…26 The THFS has a similar success rate than the PH (84% to 99%) 27 , 28 but with a lower incidence of AVN. 5 , 14 Treatment failure with the PH may be due to the fact that it can only maintain the hip in 80° to 90° of abduction by gravity. 8 Moreover, clinical outcomes will be influenced by the use of the PH, namely if it is worn appropriately and sufficiently.…”

“…In this position, the hip joint can be flexed and extended through part of the range of movement, with the pressure distributed more evenly with less tension on the vessels, which can potentially reduce the risk of AVN associated with the treatment of DDH. 3 , 14 Besides, a combination of tight adductors and rigid immobilization in extreme abduction can lead to compression of retinacular vessels leading to AVN. 34 AVN of the femoral head is the most serious complication of DDH treatment, with an average incidence rate around 8% (0% to 22%) for the PH.…”

“… 35 As with the THFS, the PH keeps the hips in flexion and abduction, while allowing some movement of the hip. 36 However, Zhou et al 14 indicated that the relatively high incidence of AVN with PH treatment could be attributed to an over-abduction of the hip due to the non-rigid design of the splint. Moreover, Novais et al 30 reported a non-negligible rate of acetabular dysplasia over a one-year period of follow-up in infants with type-IV DDH who had achieved a successful treatment using the PH.…”

“… 13 The THFS has been shown to have a similar reported treatment success rate to the PH but a lower incidence rate of AVN. 14 As such, the use of the THFS has gained popularity among paediatric orthopaedic surgeons, and it is increasingly being recognized as a useful treatment option for infants with DDH.…”