Does Brace Weaning Matter in Developmental Dysplasia of the Hip? A Comparative Study of 2 Discontinuation Strategies Following Tübingen Splint Treatment.

Abstract

Considerable practice variation persists regarding Tübingen splint discontinuation strategies in developmental dysplasia of the hip (DDH). This study compared ultrasonographic and radiographic outcomes between immediate discontinuation and gradual weaning protocols. This retrospective comparative study included 44 hips (38 patients) with Graf type IIc, D, or III DDH treated with the Tübingen splint. Twenty hips underwent immediate discontinuation upon achieving α-angle ≥60 degrees (no weaning group), while 24 hips followed a 3-month gradual weaning protocol with nighttime-only use (weaning group). Primary outcomes included final α-angle at treatment completion and acetabular index (AI) at 6 and 12 months. Statistical analysis used Wilcoxon rank-sum tests with propensity score sensitivity analysis. Groups were comparable at baseline regarding demographics and initial ultrasound findings. The weaning group achieved significantly higher final α-angles [68 degrees (IQR: 65, 70) vs. 66 degrees (IQR: 64, 68), P =0.037] and lower 12-month AI values [24 degrees (IQR: 23, 24) vs. 24 degrees (IQR: 24, 25), P =0.023]. Propensity score analysis confirmed the robustness of these findings. No surgical interventions were required in either group. A structured 3-month weaning protocol following Tübingen splint treatment was associated with small but statistically significant improvements in final α-angle and 12-month acetabular index compared with immediate discontinuation. As all hips normalized radiographically and none required intervention in either group, these absolute differences were modest and of uncertain clinical importance; weaning, therefore, appears to be a safe and reasonable option rather than a definitively superior strategy. Level III-therapeutic study.