TY - JOUR
T1 - Treatment of decentered developmental dysplasia of the hip under the age of 1 year
T2 - an evidence-based clinical practice guideline - Part 2
AU - de Witte, Pieter Bas
AU - van Bergen, Christiaan J A
AU - de Geest, Babette L
AU - Willeboordse, Floor
AU - van Linge, Joost H
AU - den Hartog, Yvon M
AU - Margret M H P Foreman-van Drongelen, Magritha
AU - Pereboom, Renske M
AU - Robben, Simon G F
AU - Burger, Bart J
AU - Witlox, M Adhiambo
AU - Witbreuk, Melinda M E H
N1 - Funding Information:
This work did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.
Publisher Copyright:
© 2022. EFORT Open Reviews.All Rights Reserved
PY - 2022/8/4
Y1 - 2022/8/4
N2 - Background and purpose: Diagnostics and treatment of developmental dysplasia of the hip (DDH) are highly variable in clinical practice. To obtain more uniform and evidence-based treatment pathways, we developed the 'Dutch guideline for DDH in children < 1 year'. This study describes recommendations for unstable and decentered hips.Materials and methods: The Appraisal of Guidelines for Research and Evaluation criteria (AGREE II) were applied. A systematic literature review was performed for six predefined guideline questions. Recommendations were developed, based on literature findings, as well as harms/benefits, patient/parent preferences, and costs (GRADE).Results: The systematic literature search resulted in 843 articles and 11 were included. Final guideline recommendations are (i) Pavlik harness is the preferred first step in the treatment of (sub) luxated hips; (ii) follow-up with ultrasound at 3-4 and 6-8 weeks; (iii) if no centered and stable hip after 6-8 weeks is present, closed reduction is indicated; (iv) if reduction is restricted by limited hip abduction, adductor tenotomy is indicated; (v) in case of open reduction, the anterior, anterolateral, or medial approach is advised, with the choice based on surgical preference and experience; (vi) after reduction (closed/open), a spica cast is advised for 12 weeks, followed by an abduction device in case of residual dysplasia.Interpretation: This study presents recommendations on the treatment of decentered DDH, based on the available literature and expert consensus, as Part 2 of the first official and national evidence-based 'Guideline for DDH in children < 1 year'. Part 1 describes the guideline sections on centered DDH in a separate article.
AB - Background and purpose: Diagnostics and treatment of developmental dysplasia of the hip (DDH) are highly variable in clinical practice. To obtain more uniform and evidence-based treatment pathways, we developed the 'Dutch guideline for DDH in children < 1 year'. This study describes recommendations for unstable and decentered hips.Materials and methods: The Appraisal of Guidelines for Research and Evaluation criteria (AGREE II) were applied. A systematic literature review was performed for six predefined guideline questions. Recommendations were developed, based on literature findings, as well as harms/benefits, patient/parent preferences, and costs (GRADE).Results: The systematic literature search resulted in 843 articles and 11 were included. Final guideline recommendations are (i) Pavlik harness is the preferred first step in the treatment of (sub) luxated hips; (ii) follow-up with ultrasound at 3-4 and 6-8 weeks; (iii) if no centered and stable hip after 6-8 weeks is present, closed reduction is indicated; (iv) if reduction is restricted by limited hip abduction, adductor tenotomy is indicated; (v) in case of open reduction, the anterior, anterolateral, or medial approach is advised, with the choice based on surgical preference and experience; (vi) after reduction (closed/open), a spica cast is advised for 12 weeks, followed by an abduction device in case of residual dysplasia.Interpretation: This study presents recommendations on the treatment of decentered DDH, based on the available literature and expert consensus, as Part 2 of the first official and national evidence-based 'Guideline for DDH in children < 1 year'. Part 1 describes the guideline sections on centered DDH in a separate article.
U2 - 10.1530/EOR-21-0126
DO - 10.1530/EOR-21-0126
M3 - (Systematic) Review article
C2 - 35924650
SN - 2058-5241
VL - 7
SP - 542
EP - 553
JO - EFORT Open Reviews
JF - EFORT Open Reviews
IS - 8
ER -