The role of weaning in brace treatment for developmental dysplasia of the hip : time to define best practice?

Aims: In infants aged under six months with developmental dysplasia of the hip (DDH), the use of a removable brace is considered the gold-standard treatment. However, considerable variation exists for brace removal after 'successful' treatment. Some clinicians support immediate cessation, while others prefer weaning of the brace. This study aimed to explore clinicians' understanding of weaning, and to identify current practices and the rationale behind different approaches, in order to inform the design of a future randomized controlled trial (RCT). Methods: A survey was developed using Google Forms and disseminated via professional networks, social media, and the British Society of Children's Orthopaedic Surgery mailing list. It targeted clinicians involved in DDH care, gathering information on demographics, treatment protocols, criteria for removal, and weaning practices. Quantitative and qualitative data were analyzed to identify patterns and variability. Results: In total, 139 clinicians from 25 countries responded, with 50% from the UK. Most respondents (87.8%) followed a protocol for brace treatment, with considerable variation in definition and implementation of weaning. 'Weaning' was most commonly defined as a gradual reduction in brace wear over time (n = 103, 74.1%). Overall, 47.4% of respondents (n = 65) reported never weaning, 39.4% (n = 54) always wean, and 13.1% (n = 18) varied their approach. Among clinicians who always wean, the most common approach involved gradually reducing the hours per day over several weeks (n = 28, 51.9%). However, for those who sometimes wean, the most frequent practice was night-time only wear (n = 8, 44.4%). Durations of weaning differed, although the majority of clinicians reported weaning periods from two to six weeks. There is broad support for a future RCT, with 75.9% (n = 105) expressing a willingness to participate. Conclusion: This survey highlights considerable variability in weaning practices for brace treatment in DDH, and underscores the need for standardized terminology and protocols. These findings provide a foundation for designing a RCT to evaluate weaning compared with immediate brace cessation, ultimately informing evidence-based guidelines.