Role of ultrasound assessment and harness treatment in the management of developmental dysplasia of the hip.

The effect of the introduction of a programme combining clinical hip screening supplemented by limited targeted ultrasound assessment on splintage for developmental dysplasia of the hip (DDH) was evaluated over a 3-year period. The use of ultrasound is of both diagnostic and therapeutic value as it allows monitoring of the effects of splintage and decreases the total treatment time required. In all, 82 dysplastic hips were identified in 65 infants and the period of splintage averaged 6.3 weeks (range 3-12 weeks). The overall splintage rate can also be reduced as hips with only minor dysplasia can be assessed by serial scans until resolution or progression occurs rather than automatic treatment of all abnormal hips and in this series the rate was 6 per 1000 (0.6%). The Wheaton-Pavlik harness is a dynamic light-weight splint which is user friendly, easy to apply and adjust, and with no major complications being encountered in this series. Unnecessary exposure to radiation was reduced as plain radiographs were not performed before ossification of the capital epiphysis; prolonged splintage was prevented and a weaning period from the brace was not used. All children remained under follow-up for 1 year after the hips were confirmed to be clinically and radiologically normal and there were no cases of late re-dislocation or subluxation. There were no cases of avascular necrosis and a markedly reduced need for diagnostic arthrograms, with only two being performed during the 3 years. This regimen has resulted in a low rate of late presenting DDH requiring surgery of 0.28/1000, as well as a low splintage rate of 6/1000 (0.6%). Most of the improvement in the results can be attributed to the more accurate evaluation of DDH by ultrasound, but the absence of avascular necrosis and other complications is likely to be due to the shorter period of time spent in a dynamic splint without the use of excessive abduction.