Optimizing early hip maturation strategies in neonatal hip immaturity and dysplasia: a cohort study and network meta-analysisResearch in context
Summary: Background: Early intervention is crucial for optimizing hip maturation in developmental dysplasia of the hip (DDH). This study evaluates the clinical effectiveness of various conservative management approaches. Methods: We employed a dual-approach methodology combining original research w...
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Elsevier
2025-08-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537025002767 |
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| author | Yu-Cheng Su Ying-Yu Wang Pei-Chun Lai Yu-Kang Tu Chih-Kai Hong Ming-Tung Huang Chii-Jeng Lin Su-Ying Lee Che-Wei Lin Ching-Ju Fang Po-Ting Wu Fa-Chuan Kuan Kai-Lan Hsu Jou-Hua Wang Chien-An Shih |
| author_facet | Yu-Cheng Su Ying-Yu Wang Pei-Chun Lai Yu-Kang Tu Chih-Kai Hong Ming-Tung Huang Chii-Jeng Lin Su-Ying Lee Che-Wei Lin Ching-Ju Fang Po-Ting Wu Fa-Chuan Kuan Kai-Lan Hsu Jou-Hua Wang Chien-An Shih |
| author_sort | Yu-Cheng Su |
| collection | DOAJ |
| description | Summary: Background: Early intervention is crucial for optimizing hip maturation in developmental dysplasia of the hip (DDH). This study evaluates the clinical effectiveness of various conservative management approaches. Methods: We employed a dual-approach methodology combining original research with systematic evidence synthesis. First, we conducted a prospectively-designed retrospective cohort study from January 2021 to December 2023, comparing three treatment approaches in 103 hips: Pavlik harness (n = 35), double diapering (n = 39), and observation (n = 29), with 12-month follow-up. Second, we performed a network meta-analysis (NMA) registered in PROSPERO (CRD42024591239) to synthesize broader evidence on treatment effectiveness. We systematically searched MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to April 15, 2025, without language restrictions. The NMA included 9 studies (6 randomized, 3 non-randomized) encompassing 681 hips and compared five interventions: dynamic splinting (with/without sequential weaning), static splinting, observation, double diapering, and Mongolian swaddling. Primary outcomes were alpha angle improvement and normalization rates; secondary outcomes included treatment switching and adverse events. Findings: Pavlik harness showed superior one-month improvements in alpha angle (11.0° ± 5.1° versus 8.5° ± 2.9° versus 5.4° ± 4.5°, p < 0.0001) and femoral head coverage (0.149 ± 0.094 versus 0.081 ± 0.063 versus 0.053 ± 0.081, p < 0.0001) compared to double diapering and observation. The NMA revealed greater alpha angle improvements with dynamic splinting without weaning and double diapering versus observation [weighted mean difference (wMD): 3.34° (95% CI: 1.84–4.84, p < 0.0001) and 2.41° (0.72–4.10, p = 0.0052)]. Double diapering achieved higher normalization rates [weighted risk ratio (wRR): 1.47 (1.20–1.79, p = 0.0002)], while Mongolian swaddling increased failure risk [wRR: 0.65 (0.47–0.85, p = 0.0044)]. Dynamic splinting [wRR: 0.12 (0.04–0.38, p = 0.00022)] and dynamic splinting with sequential weaning [wRR: 0.05 (0.01–0.20, p < 0.0001)] reduced treatment switching rates. Adverse event rates were comparable across all interventions. Interpretation: Both dynamic splinting and double diapering effectively promote hip maturation in cases of hip immaturity (Graf IIa), with dynamic splinting producing more rapid improvements. For both immature and dysplastic hips (all Graf ≥ IIa), dynamic splinting appears to be the most effective treatment overall, while double diapering offers a viable alternative. Funding: This study was supported by grants from the National Science and Technology Council (NSTC 113-2314-B-006-090-, awarded to Chien-An Shih; NSTC 113-2314-B-006-085- and NSTC 113-2640-B-006-004-, awarded to Kai-Lan Hsu) and National Cheng Kung University Hospital (NCKUH-11404024, awarded to Chien-An Shih; NCKUH-11402044, awarded to Kai-Lan Hsu). |
| format | Article |
| id | doaj-art-5ca5a87c49fc4aab8c9e274e35e2a997 |
| institution | Kabale University |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj-art-5ca5a87c49fc4aab8c9e274e35e2a9972025-08-20T03:29:10ZengElsevierEClinicalMedicine2589-53702025-08-018610334410.1016/j.eclinm.2025.103344Optimizing early hip maturation strategies in neonatal hip immaturity and dysplasia: a cohort study and network meta-analysisResearch in contextYu-Cheng Su0Ying-Yu Wang1Pei-Chun Lai2Yu-Kang Tu3Chih-Kai Hong4Ming-Tung Huang5Chii-Jeng Lin6Su-Ying Lee7Che-Wei Lin8Ching-Ju Fang9Po-Ting Wu10Fa-Chuan Kuan11Kai-Lan Hsu12Jou-Hua Wang13Chien-An Shih14Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, TaiwanDepartment of Anesthesiology, National Taiwan University Hospital, Taipei, TaiwanEducation Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanInstitute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, TaiwanDepartment of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Orthopedic Surgery, Show Chwan Memorial Hospital, Changhua, TaiwanDepartment of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Biomedical Engineering, National Cheng Kung University, Tainan, TaiwanDepartment of Secretariat, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Library, National Cheng Kung University, Tainan, TaiwanDepartment of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedics, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan; Corresponding author. Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan 704, Taiwan.Summary: Background: Early intervention is crucial for optimizing hip maturation in developmental dysplasia of the hip (DDH). This study evaluates the clinical effectiveness of various conservative management approaches. Methods: We employed a dual-approach methodology combining original research with systematic evidence synthesis. First, we conducted a prospectively-designed retrospective cohort study from January 2021 to December 2023, comparing three treatment approaches in 103 hips: Pavlik harness (n = 35), double diapering (n = 39), and observation (n = 29), with 12-month follow-up. Second, we performed a network meta-analysis (NMA) registered in PROSPERO (CRD42024591239) to synthesize broader evidence on treatment effectiveness. We systematically searched MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to April 15, 2025, without language restrictions. The NMA included 9 studies (6 randomized, 3 non-randomized) encompassing 681 hips and compared five interventions: dynamic splinting (with/without sequential weaning), static splinting, observation, double diapering, and Mongolian swaddling. Primary outcomes were alpha angle improvement and normalization rates; secondary outcomes included treatment switching and adverse events. Findings: Pavlik harness showed superior one-month improvements in alpha angle (11.0° ± 5.1° versus 8.5° ± 2.9° versus 5.4° ± 4.5°, p < 0.0001) and femoral head coverage (0.149 ± 0.094 versus 0.081 ± 0.063 versus 0.053 ± 0.081, p < 0.0001) compared to double diapering and observation. The NMA revealed greater alpha angle improvements with dynamic splinting without weaning and double diapering versus observation [weighted mean difference (wMD): 3.34° (95% CI: 1.84–4.84, p < 0.0001) and 2.41° (0.72–4.10, p = 0.0052)]. Double diapering achieved higher normalization rates [weighted risk ratio (wRR): 1.47 (1.20–1.79, p = 0.0002)], while Mongolian swaddling increased failure risk [wRR: 0.65 (0.47–0.85, p = 0.0044)]. Dynamic splinting [wRR: 0.12 (0.04–0.38, p = 0.00022)] and dynamic splinting with sequential weaning [wRR: 0.05 (0.01–0.20, p < 0.0001)] reduced treatment switching rates. Adverse event rates were comparable across all interventions. Interpretation: Both dynamic splinting and double diapering effectively promote hip maturation in cases of hip immaturity (Graf IIa), with dynamic splinting producing more rapid improvements. For both immature and dysplastic hips (all Graf ≥ IIa), dynamic splinting appears to be the most effective treatment overall, while double diapering offers a viable alternative. Funding: This study was supported by grants from the National Science and Technology Council (NSTC 113-2314-B-006-090-, awarded to Chien-An Shih; NSTC 113-2314-B-006-085- and NSTC 113-2640-B-006-004-, awarded to Kai-Lan Hsu) and National Cheng Kung University Hospital (NCKUH-11404024, awarded to Chien-An Shih; NCKUH-11402044, awarded to Kai-Lan Hsu).http://www.sciencedirect.com/science/article/pii/S2589537025002767Developmental dysplasia of hipNetwork meta-analysisDynamic splintingDouble diaperingConservative managementJCT |
| spellingShingle | Yu-Cheng Su Ying-Yu Wang Pei-Chun Lai Yu-Kang Tu Chih-Kai Hong Ming-Tung Huang Chii-Jeng Lin Su-Ying Lee Che-Wei Lin Ching-Ju Fang Po-Ting Wu Fa-Chuan Kuan Kai-Lan Hsu Jou-Hua Wang Chien-An Shih Optimizing early hip maturation strategies in neonatal hip immaturity and dysplasia: a cohort study and network meta-analysisResearch in context EClinicalMedicine Developmental dysplasia of hip Network meta-analysis Dynamic splinting Double diapering Conservative management JCT |
| title | Optimizing early hip maturation strategies in neonatal hip immaturity and dysplasia: a cohort study and network meta-analysisResearch in context |
| title_full | Optimizing early hip maturation strategies in neonatal hip immaturity and dysplasia: a cohort study and network meta-analysisResearch in context |
| title_fullStr | Optimizing early hip maturation strategies in neonatal hip immaturity and dysplasia: a cohort study and network meta-analysisResearch in context |
| title_full_unstemmed | Optimizing early hip maturation strategies in neonatal hip immaturity and dysplasia: a cohort study and network meta-analysisResearch in context |
| title_short | Optimizing early hip maturation strategies in neonatal hip immaturity and dysplasia: a cohort study and network meta-analysisResearch in context |
| title_sort | optimizing early hip maturation strategies in neonatal hip immaturity and dysplasia a cohort study and network meta analysisresearch in context |
| topic | Developmental dysplasia of hip Network meta-analysis Dynamic splinting Double diapering Conservative management JCT |
| url | http://www.sciencedirect.com/science/article/pii/S2589537025002767 |
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