Background: The general consensus is that nonoperative treatment of
developmental dysplasia of the hip should not be attempted for patients in
whom previous treatment of the disease has failed, those in whom the disease
was neglected, or those in whom the disease presented late. In such cases, it
is believed that the optimum period for hip remodeling has passed and that
operative methods are preferable. The purpose of the present study was to
report the efficacy of a modified form of the Hoffmann-Daimler method for the
treatment of late-presenting developmental dysplasia of the hip.
Materials: We retrospectively reviewed the records of sixty-nine
patients (ninety-five hips) with neglected developmental dysplasia of the hip
who had been managed nonoperatively with a modification of the
Hoffmann-Daimler method from 1971 to 2000. With this method, the patient wears
a flexion harness (Phase A), during which time the femoral head is gradually
reduced, followed by an abduction splint (Phase B), during which time the
reduced hip remodels. We have modified the original method by introducing new
treatment strategies. The study group included nine boys and sixty girls. The
average age of the patients was sixteen months (range, six to forty-four
months) at the start of treatment and 11.5 years (range, six to twenty-nine
years) at the time of the latest follow-up. Radiographs were assessed to
determine the acetabular index, the Severin classification, and the presence
of evidence of osteonecrosis of the proximal femoral epiphysis. Hips that were
rated as Severin class I or class II were classified as satisfactory, whereas
those that were rated as Severin class III or class IV were classified as
Results: On the basis of the most recent follow-up radiographs,
eighty-eight (93%) of the dislocated hips were classified as satisfactory
(sixty-seven were rated as Severin class I and twenty-one were rated as
Severin class II) and seven were classified as unsatisfactory (six were rated
as Severin class III and one was rated as Severin class IV). No hip was rated
as Severin class V or VI. The average acetabular index was 40° ±
7.4° prior to the onset of treatment and 24° ± 5.7° at the
end of treatment. No redislocations or other complications were noted.
Osteonecrosis was noted in six of the ninety-five hips.
Conclusions: Late-presenting or neglected developmental dysplasia of
the hip can be successfully treated with use of a modified Hoffmann-Daimler
method. The high rate of successful reduction, the low prevalence of
osteonecrosis and residual dysplasia, and the limited complications may make
this modified method a safe alternative to surgical treatment.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.