When treating developmental dysplasia of the hip (DDH), achieving good outcomes is higher when therapy is initiated before the age of three months. Despite screening programs, some infants are not identified and start therapy only after the age of one year. For these infants there is no consensus on treatment alternatives. Study purpose: To assess what proce¬dures are in use and have withstood the test of time. Patients and methods: The study is a retrospective cohort study. Inclusion criteria: DDH patients ≥ 1 year of age treated between 2012-2021 and with available follow-up. Treatment outcomes were assessed for: a) severity of dislocation: Tönnis classification b) for accuracy of reduction: Severin’s Classification c) For avascular necrosis of the femoral head (AVN): Kalamchi and MacEwen classification d) functional results: Children Hospital of Oakland Hip Evaluation Score (CHOEHES). Results: The cohort included 41 children (48 treated hips). Mean age at surgery was 20.375 +/-6.75 months. Mean follow up was for 55.14/- 36.44 months. Open reduction was done in 21 hips while 27 hips underwent closed reduction. Femur and / or periacetabular osteotomies were sometimes performed in the same session. The protocol that includes open reduction, subtrochanteric femoral shortening plus derotation and a peri-acetabular osteotomy done in the same session achieved optimal outcomes - in 19/20 treated hips . Open reduction did not increase the rate of AVN. Conclusion: Optimal results can be achieved, even in the age group 1 -3 years with potential to delay osteoarthrosis indefinitely.

Introduction: This study aimed to evaluate the management of patients with a Spica cast as a therapeutic treatment for developmental dysplasia of the hip DDH. Methods: A questionnaire about general information, nutrition, hygiene, clothing and child managementwas somministraredto all patients’ families who underwent closed reduction and Spica cast between May 2008 and January 2019.Thescores were compared between two groups differing in age (children <6months vs. >6months). Results: Fifty-two patientswere sent the questionnaires and 43 (56%, 24<6 months and 44%, 19>6 months) of them responded. Closed reduction and Spica cast were performed at a medium age of 6.11+4.69 months, 53 hips with 10 bilateral, 23 left and 10 right sides DDH. Conclusion: Our study demonstrates the importance of investigating the best solutions in the management of the child with Spica cast. It also explores and analyzes the perspective of families in the management of the Spica cast in critical areas.

Among the many newborns’ medical conditions which might interfere with mothers’ mental health, developmental dysplasia of the hip (DDH) appears thus far uninvestigated. The present study aimed at contributing to fill this gap by exploring mothers’ mental health at the time of diagnosis and by the end of treatment; possible moderators were mothers’ hip worries, compliance to treatment and severity of babies’ DDH. Method: The sample included 60 mother-infant dyads, all diagnosed with either moderate or severe/very severe DDH, 33 of which were followed longitudinally. Were administered: The Parenting Stress Index–Short Form (PSI-SF), The Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) , The Infant Hip Worries Inventory (IHWI) , The Infant Hip Worries Inventory (IHWI) , Clinicians’ Perception of Parental Compliance With Treatment for DDH, Degree of severity of dysplasia. Among the main results, multilevel models showed that the mothers’ psychological condition remained stable over time. The mothers’ hip worries, compliance to treatment and severity of babies’ DDH did not moderate the mothers’ mental health over time but were significant independent predictors of it. Findings have important implications for interventions to support parents in the presence of DDH.

Aims: Ultrasound (US) is the gold standard for screening developmental dysplasia of the hip (DDH) in infants. We tested whether it is feasible to use a novel application using AI analysis of cine sweep hip ultrasound images to improve the early detection of DDH in infants. Methods: We performed US on infants presenting for immunization between age 6-10 weeks. Each infant received a traditional scan (TS) and a cine sweep (CS) on which AI assessment was performed. MEDO hip app was utilized for evaluation of the scans. Feasibility of application was measured by user feedback assessment, rates of adequate/inadequate scans and cost of scanning. Secondary outcomes included estimates of positive and negative predictive values of screening hip US for DDH, rates of DDH that are being missed without screening, and caregiver satisfaction with an US-guided infant DDH screening program. Results: 307 children (614 hips) were analyzed. 88 hips with dysplasia were identified in these scans: 80 Graf IIa, 5 Graf IIB and 1 Graf III & IV each. The average scanning time was 198 seconds for TS and 89 seconds for cine sweep. Suboptimal scans were seen in only 27 hips (4.4%). Assessor satisfaction was >80/100 using System Usability Scale and parents rated an average 4.73/5 on overall satisfaction with the screening process. Conclusion: AI-assisted cine sweep US for screening of DDH can successfully be implemented for fast and effective screening of DDH especially in peripheral region where skilled MSK sonologists are not available.

Introduction: The management of IHDI 2 hips following “successful” Pavlik harness treatment is controversial with no consensus. Treatment includes Active Monitoring, Abduction Bracing, Abduction Casting or Closed Reduction.
Aim: To assess the remodelling potential of IHDI grade 2 hips (Identified at 6 months old) following “successful” Pavlik harness treatment, and outcomes of subsequent treatment modalities.
Methods: Retrospective cohort study included children diagnosed with DDH treated with a Pavlik harness between 2015- 2018 at the RNOH. We included hips graded IHDI 2 on their 6 months follow up X-ray and excluded neuromuscular, syndromic or genetic conditions with abnormal tone and those lost to follow up. Demographics, treatments and radiographs (Acetabular Index, IHDI grade and Shenton's line) were reviewed at different age groups: 6 months, 12-24 months, and 3-5 years. Radiographs were analysed by two fellowship trained paediatric orthopaedic surgeons.
Results: 58 IHDI 2 hips were included from a database of 424. Treatment modalities included : active monitoring (N=37, 63.8%%) abduction brace N=(12, 20.6%), abduction casting (N=3, 5.2%) and closed reduction (N=6, 10.4%). 57/58 (98.3%) hips improved to IHDI 1 at the final follow up regardless of treatment modality (1 diagnosed late with ipsilateral tibial hemimelia). 26/58 (44.8%) normalised to IHDI 1 after 12-24 months. 15.5% (9/58) had an Acetabular Index >25° at final follow up. Shenton's line was broken in 77.6% of X-rays at 6 months, improving to 12% at final follow up.
Conclusion: We feel Active Monitoring for residual IHDI 2 hips following “successful” Pavlik Harness treatment is justifiable.