Treatment of Clinical Instability
Limited evidence supports either immediate or delayed (2-9 weeks) brace treatment for hips with a positive instability exam.

For infants with a positive hip instability exam, there is conflicting evidence about whether a period of observation or immediate brace treatment leads to a difference in later dysplasia or persistent hip instability leading to later brace treatment. One moderate strength and three low strength studies looked at radiographic differences between an early versus late brace treatment group. 24, 25(follow-up), 26, 27, 28 None of these studies differentiate dislocated from dislocatable hips.

Gardiner found a significant difference in the radiographic appearance of the femoral capital epiphysis and delayed iliac indentation at 6 months for a no treatment group compared to a brace group.25 Twenty-nine percent of the non-treatment group had cross-over and were treated at two weeks. Limitations were not defining the femoral capital epiphyseal ossification subcategories and iliac indentation and not explaining the relevance of either. 
Molto compared Von Rosen splinting immediately after birth to splinting after two weeks. 26 The outcome criterion was acetabular index. They noted a significant improvement in the acetabular index at 15 months in the immediate treatment group (76 patients) as compared to the 27 patients in the second group treated after two weeks.

Paton reported on 75 hips in 2 groups, including 37 patients (59 hips) in the early splint treatment group versus 11 patients (16 hips) in the late splint treatment group.27 Outcome measures included continued instability that required late splint treatment after six weeks, radiographic abnormality, AVN, or surgical intervention at walking age. Authors noted no significant differences when treatment started at less than one week in the early treatment group versus nine weeks on average in the delayed treatment group. This study included both dislocatable and dislocated hips with outcome measures not specifically correlated to the nature of the instability.

The risks/harms of this recommendation are overtreatment and the potential complications and burden of care.


The Future of OrthoGuidelines


The OrthoGuidelines Process