Postoperative Cast Immobilization Might Be Unnecessary after Pelvic Osteotomy for Children with Developmental Hip Dysplasia: A Systematic Review

Background: Developmental dysplasia of the hip (DDH) is a common disorder of atypical hip development. Pelvic osteotomy (e.g., according to Salter, Pemberton or Dega) may be indicated for children with DDH at walking age. The most popular postoperative treatment is a hip spica cast. Alternative postoperative options include abduction braces and non-weightbearing protocols combined with physical therapy. The aim of this systematic review was to determine the most effective form of postoperative treatment after unilateral pelvic osteotomy in children with DDH in terms of clinical and radiological outcomes and complications. Methods: A systematic review was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines and registered in the international prospective register of systematic reviews. Articles were selected from PubMed, Embase and Cochrane databases. The quality of all (non-)randomized included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: The search strategy yielded 3524 articles. Fourteen articles with 367 total hips were included in this review. A total of 312 hips were treated with spica casts, 49 with abduction braces and 6 with non-weightbearing protocols. The quality of evidence was moderate (MINORS, 3-12 points). All types of postoperative treatments had good clinical outcomes overall, without secondary displacement of the osteotomy. Clinical outcomes for spica casts were reported according to McKay's criteria in 135 hips, with 123 excellent and 12 good results. Clinical outcomes for abduction braces showed satisfaction for all parents (49 of 49). The radiological outcome was overall well preserved with any postoperative treatment. There was a higher complication rate with the use of hip spica casts, including avascular necrosis, pain complaints and superficial infections. Conclusion: This systematic review showed no benefit of postoperative spica casts compared with abduction braces and avoidance of weightbearing after simple pelvic osteotomy for residual DDH.