One-year outcomes of the implementation of a comprehensive education-based care protocol for developmental dysplasia of the hip: A cohort study.

BACKGROUND: Developmental dysplasia of the hip (DDH) can cause long-term disability if left untreated. Preventive and supportive strategies include educating caregivers on safe swaddling, babywearing, and appropriate infant handling. This study determined the time to hip ultrasonographic normalization during year 1 in infants with DDH and explored factors associated with recovery, focusing on the association between comprehensive nurse-led education-based care and hip normalization. METHODS: This retrospective cohort study included infants who received a DDH diagnosis at Changhua Christian Children's Hospital between April 2022 and December 2023. All infants were monitored for 1 year. Cox proportional hazards regression with Firth's penalized likelihood was performed to identify factors associated with recovery. RESULTS: The study cohort comprised 58 infants: 31 (53.4%) with Graf type IIc hips, 25 (43.1%) with type D hips, and 2 (3.4%) with type III hips. During follow-up, 50 (86.2%) infants achieved hip ultrasonographic normalization, whereas 8 (13.8%) did not. Of the infants, 69.2% achieved ultrasonographic normalization within 184 days, and 100% achieved it within 1 year. Nurse-led education-based care and a lower initial Graf stage of the left hip were significantly associated with a shorter time to hip normalization. Furthermore, a combination of nurse-led education-based care and Pavlik harness treatment was associated with ultrasonographic normalization. CONCLUSIONS: Recovery from DDH is determined by multiple clinical and care-related factors. Nurse-led education-based care may serve as a complementary component of DDH management. Notably, it is a supportive strategy that complements, rather than replaces, conventional Pavlik harness treatment.