MODERATE RECOMMENDATION There are no high-quality comparative effectiveness studies between different types of braces for the treatment of DDH. Limited evidence suggests that rigid braces may have higher rates of resolution of hip dysplasia than non-rigid braces. Two low strength studies (Heikkila 1988, Wilkinson 2002) compared rigid bracing to soft bracing for initial treatment of unstable hips in infants. Heikkila (1988) compared the Frejka pillow with the von Rosen splint. There were 920 patients treated with Frejka pillow and 180 patients treated with von Rosen splint. Fifty-five of 920 from the Frejka pillow group had treatment failure, while 1 out of 180 from the von Rosen splint group failed treatment. These differences were significant. A limitation of this study is that it was a historical comparative study of two cohorts over two time periods. AVN rates were inadequately reported. The authors did not differentiate between dislocated and dislocatable hips.
Three splints were compared in the Wilkinson (2002) study: Craig, Pavlik, and von Rosen. Four of 28 in the Craig splint group, 13 of 43 in the Pavlik group, and 0 of 26 in the von Rosen group required further treatment in the form of plaster or operation.
This recommendation is based on the braces that were studied, but other similar fixed-position braces may or may not work as well as the braces mentioned in the evidence.
RISKS AND HARMS
Nineteen percent of the patients in the rigid brace group experienced skin irritation(Heikkila 1988). There is a potential risk of AVN with all bracing; the relative risk is unknown between rigid and soft bracing.
2022 UPDATE ADDITIONAL EVIDENCE
1. Azzoni, R., Cabitza, P. A comparative study on the effectiveness of two different devices in the management of developmental dysplasia of the hip in infants. Minerva pediatrica 2011; 5: 355-361
2. Ran, L., Chen, H., Pan, Y., Lin, Q., Canavese, F., Chen, S. Comparison between the Pavlik harness and the Tubingen hip flexion splint for the early treatment of developmental dysplasia of the hip. J Pediatr Orthop B 2019; 0:
3. Zidka, M., Dzupa, V. Pavlik harness and Frejka pillow: compliance affects results of outpatient treatment. Arch Orthop Trauma Surg 2019; 11: 1519-1524
- (29) Heikkila E. Comparison of the Frejka pillow and the von Rosen splint in treatment of congenital dislocation of the hip. J Pediatr Orthop 1988;8(1):20-21.
- (28) Wilkinson AG, Sherlock DA, Murray GD. The efficacy of the Pavlik harness, the Craig splint and the von Rosen splint in the management of neonatal dysplasia of the hip. A comparative study. J Bone Joint Surg Br 2002;84(5):716-719.
- Azzoni, R., Cabitza, P. A comparative study on the effectiveness of two different devices in the management of developmental dysplasia of the hip in infants. Minerva pediatrica 2011; 5: 355-361
- Ran, L., Chen, H., Pan, Y., Lin, Q., Canavese, F., Chen, S. Comparison between the Pavlik harness and the Tubingen hip flexion splint for the early treatment of developmental dysplasia of the hip. J Pediatr Orthop B 2019; 0:
- Zidka, M., Dzupa, V. Pavlik harness and Frejka pillow: compliance affects results of outpatient treatment. Arch Orthop Trauma Surg 2019; 11: 1519-1524