Developmental dysplasia of the hip is the most common bone and joint condition in babies. It is usually treated with a harness that holds the hips in a safe position so they can develop normally. After the hip is confirmed to be in the correct position, babies are commonly kept in the harness for up to 12 weeks or more. While effective, wearing a harness for this length of time can be challenging for families. It can make everyday care such as feeding, bathing and dressing more difficult, and add stress during an important time for bonding.
This trial compares two treatment options: 8 versus 12 weeks of harness wear. The 8-week option is being tested because research has shown that most hips appear normal on ultrasound by this point. The main measure of success is whether the hip looks normal on x-ray two years after treatment. Families will also be asked about their experience and treatment-related problems.
If the shorter option is as effective as the longer option, many babies could spend less time in brace, reducing burden without compromising outcomes. Because this trial is embedded in routine care, results can be put into practice quickly and guide care for babies across Ontario and beyond.
Age: <= 6 months of chronological age at time the maturation period is initiated (hip centred).
Decentred hip at presentation (subluxated/dislocated, femoral head coverage < 40%)
Centred dysplastic hip at presentation (femoral head coverage ≥ 40%, α < 60°)
Treatment plan: Deemed suitable for Pavlik harness as per institutional guidelines.
Previous treatment: Prior use of Pavlik harness, alternative brace, or surgical intervention for DDH. (Clarification: for infants presenting with decentred hips, enrolment is only after sonographic centring; the pre-enrolment harnessing used to achieve centring does not constitute prior treatment, and does not preclude participation)
Decentred hips failing to centre by 3 weeks in harness, requiring transition to fixed abduction brace or surgical reduction.
Secondary non-idiopathic dysplasia: Known neuromuscular disorders, connective tissue disorders, or genetic syndromes (e.g. spina bifida, arthrogryposis, Ehlers-Danlos syndrome).
Prematurity: Infants born at <34 weeks gestational age.
Parallel
Pavlik Harness
DeviceThe intervention is the duration of Pavlik harness use after sonographic centring. The Pavlik harness itself is unchanged: a commercially available soft brace positioning the hips in flexion and abduction to maintain reduction. No modifications are introduced to fitting technique, wear schedule, caregiver education, skin checks, or monitoring. All care follows the existing SickKids protocol used in routine practice. The harness is worn full time (24 hours/day initially), with allowance for up to 1 hour/day removal for hygiene after 5 weeks of treatment.
Acetabular Index at 24 Months of Age
Acetabular index, measured in degrees using the lateral-edge method on a standardised anteroposterior pelvic radiograph, will be assessed for the prespecified index hip. Two independent assessors blinded to treatment allocation will measure each radiograph, and the mean of their measurements will be used for analysis. The mean acetabular index will be compared between the 8-week and 12-week Pavlik harness treatment groups. The non-inferiority margin is 2°.
Caregiver-Reported Experience Measured Using the EMBRACE Tool
Caregiver-reported experience with Pavlik harness treatment will be assessed using the Evaluation Measure for BRACe Experience (EMBRACE), a DDH-specific questionnaire. An overall EMBRACE score will be calculated according to the instrument's prespecified scoring method. Scores range from 8 to 40, with higher scores indicating a better experience.
Caregiver Reported Impact of Harness Treatment on the Infant Using VAS Item
The caregiver will rate the perceived impact of Pavlik harness treatment on the infant using a 0-10 visual analogue scale. A score of 0 indicates low child discomfort/distress and a score of 10 indicates high child discomfort/distress.
Caregiver Reported Impact of Harness Treatment on the Caregiver Using VAS Item
The caregiver will rate the perceived impact of Pavlik harness treatment on themselves using a 0-10 visual analogue scale. A score of 0 indicates low burden and a score of 10 indicates high burden.
Caregiver Reported Impact of Harness Treatment on the Family Using VAS Item
The caregiver will rate the perceived impact of Pavlik harness treatment on the family using a 0-10 visual analogue scale. A score of 0 indicates low family burden and a score of 10 indicates high family burden.
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