Dynamic and Static Splinting for Treatment of Developmental Dysplasia of the Hip: A Systematic Review

Background: Developmental dysplasia of the hip (DDH) is one of the most common pediatric conditions. The current gold-standard treatment for children under six months of age with a reducible hip is bracing, but the orthopedic literature features several splint options, and each one has many advantages and disadvantages. The aim of this review is to analyze the available literature to document the up-to-date evidence on DDH conservative treatment. Methods: A systematic review of PubMed and Science Direct databases was performed by two independent authors (C.d.C. and A.V.) using the keywords “developmental dysplasia hip”, “brace”, “harness”, “splint”, “abduction brace” to evaluate studies of any level of evidence that reported clinical or preclinical results and dealt with conservative DDH treatment. The result of every stage was reviewed and approved by the senior investigators (V.P. and G.T.). Results: A total of 1411 articles were found. After the exclusion of duplicates, 367 articles were selected. At the end of the first screening, following the previously described selection criteria, we selected 29 articles eligible for full text reading. The included articles mainly focus on the Pavlik harness, Frejka, and Tubingen among the dynamic splint applications as well as the rhino-style brace, Ilfeld and generic abduction brace among the static splint applications. The main findings of the included articles were summarized. Conclusions: Dynamic splinting for DDH represents a valid therapeutic option in cases of instability and dislocation, especially if applied within 4–5 months of life. Dynamic splinting has a low contraindication. Static bracing is an effective option too, but only for stable hips or residual acetabular dysplasia.

Early failure for wear after ceramic-on-highly cross-linked polyethylene total hip arthroplasty: a case report

Background Highly cross-linked polyethylene (HXLPE) enhances the anti-wear characteristics of the conventional polyethylene (PE). Early failure for wear after ceramic-on-highly cross-linked polyethylene (CoHXLPE) total hip arthroplasty (THA) is extremely rare. Case presentation We described the case of a 60-year-old man who underwent right CoHXLPE THA because of the developmental dysplasia hip (DDH) complained pain 32 months after this procedure. Plain radiographs showed that eccentric wear existed at the polyethylene insert. However, the patient refused surgery at that time and did not stop weight-bearing. The right hip pain continued for 7 months. Plain radiographs of the pelvis showed that the HXLPE liner was penetrated and partial inner wall of acetabular shell was worn. Acetabular cup revision was performed, and the ceramic head and HXLPE were exchanged. Conclusions Difficult reduction during primary THA, especially for DDH, can result in higher abductor tension, which may lead to early eccentric wear of the prosthesis. Whenever eccentric wear of HXLPE liner was found, weight-bearing must be stopped to avoid the accelerated wear and adverse reactions to metal debris (ARMD).