Examining Practice Variability in Post-Operative Immobilization Following Closed or Open Reduction for Developmental Dysplasia of the Hip

Schaeffer EK, Bade D, Aroojis A, Pun S, Mulpuri K. Examining Practice Variability in Post-Operative Immobilization Following Closed or Open Reduction for Developmental Dysplasia of the Hip. Canadian Orthopaedic Association Meeting, Vancouver, BC, Canada. June 2025.

Abstract

Purpose:

Currently, no consensus exists on postoperative immobilization practices following closed (CR) or open reduction (OR) to treat developmental dysplasia of the hip (DDH). There is substantial debate about immobilization type and duration following these procedures, and a clearer understanding is needed to optimize outcomes and minimize complications. The purpose of this study was to examine the existing practice variability in post-operative immobilization after CR or OR globally.

Method:

A global, prospective registry of infants and children diagnosed with DDH was analyzed for patients undergoing CR or OR, either as primary management or secondary to failed brace treatment. Only the first instance of CR or OR was considered for each hip, and osteotomies alone were excluded from analysis. Demographic and diagnostic variables included age at diagnosis/surgery, sex, percent coverage of the femoral head on ultrasound and IHDI classification on radiograph. Postoperative variables included hip spica type, duration, cast changes, and post-spica bracing. Categorical variables were summarized using frequencies and percentages, and continuous variables were summarized using means and standard deviations (SD) or medians and quartile ranges.

Results:

In total, 395 hips (291 patients) underwent CR alone, 639 hips (512 patients) underwent OR alone, and 115 hips (94 patients) underwent both CR and OR; 83.4% of patients were female. Mean age at diagnosis was 20.7 months (SD 24), with a mean age of 11.3 months (6.3) at first CR and 27.1 months (25.9) at first OR. 78.3% of patients were diagnosed by radiograph, with 50.3% of those at IHDI grade IV. Postoperatively, hip spica type varied considerably, with the double hip spica most common (53.8%) followed by a one-and-a-half spica (33.7%). Hip spica was changed in 33.1% of cases, with 91.4% of those changes being routine postoperative management. Soiled cast was the most common complication necessitating spica cast change. The one-and-a-half leg spica was the most common type for the second hip spica (47.9%). Duration of hip spica varied substantially, with a median of 83 days (Q1,Q3:63,93) and 45 days (40,68.25) for first and second spica, respectively. Patients were transitioned to a brace post-spica in 68.5% of cases. Brace type was highly variable, with Rhino Cruiser being most common (31.8%).

Conclusion:

This study highlights substantial practice variability regarding spica cast type, duration of spica cast treatment and post-spica brace choices post-CR or OR for DDH. Our findings indicate the need to systematically examine outcomes to provide high-level evidence to guide management choices and improve functional and clinical patient outcomes.