Do We Need to Change Hip Spica Halfway Through Immobilization Following Closed Reduction for Developmental Dysplasia of the Hip

Abstract

Objectives: Closed reduction (CR) is a well-established method for treating developmental dysplasia of the hip (DDH). Traditionally, the child is placed in a spica cast after DDH CR for three to four months and it is common practice to change the spica under general anesthesia after 6–8 weeks. To our knowledge, no previous studies have shown that changing the spica is necessary. We hypothesize that there is no need to change the spica and that it can be safely retained for three months without any significant complications. Methods: We used our department database to find all children who had DDH CR and a spica cast for a minimum of 90 days over a one-year period (March 2018 to March 2019) and who had at least a one year follow up after removal of the cast. We retrospectively reviewed the medical notes and radiographs, looking at complications that may be attributed to prolonged use of spica. Results: Thirty-nine patients (48 hips) met our criteria. None of the patients developed any cast-related complications during or after removal of the spica cast. No abdominal, joint or skin complications were reported throughout treatment. At one year follow up, there were no complications that could be attributed to using the spica for three months.  Conclusion: Changing the spica every 6–8 weeks after DDH CR is of no benefit and exposes the infant to an unnecessary general anesthesia, with the risk of losing the hip reduction. We conclude that it is very safe to keep the spica cast on for three months without changing after DDH CR. We recommend changing practice to reflect our findings.