Developmental Dysplasia of the Hip: Observation vs. Bracing

This study addresses a common pediatric orthopedic question: when a newborn's hip ultrasound shows mild radiological dysplasia (an underdeveloped hip socket) but the hip is clinically stable, is it better to observe the baby and allow natural maturation, or to immediately apply a Pavlik harness (a soft brace)? Developmental dysplasia of the hip (DDH) affects a significant number of infants, but mild forms often resolve on their own — yet without treatment, a small number will worsen and require more invasive correction. The trial aims to define which approach leads to better outcomes with fewer over-treated babies. Eligible infants are under 12 weeks old with ultrasound-confirmed hip dysplasia (alpha angle 43–60 degrees, femoral head coverage above 35%) and clinically stable hips. Infants older than 12 weeks, those with unstable hips (positive Ortolani or Barlow test), known neuromuscular or chromosomal conditions, or those already treated with a harness are excluded. Infants are randomized to watchful waiting or Pavlik harness and monitored with serial hip ultrasounds. This study is important because overtreatment of mild DDH is common — bracing has its own risks including avascular necrosis of the femoral head — and evidence-based guidance on which babies truly need early intervention would improve care for thousands of newborns annually.