# Residual Acetabular Dysplasia in Young Children: a Comprehensive Review of Diagnosis and Management

## TL;DR

This paper reviews how to diagnose and treat residual acetabular dysplasia in young children to prevent hip problems later in life.

## Contribution

The paper provides updated evidence on non-surgical and surgical treatment effectiveness for managing residual acetabular dysplasia in children.

## Key findings

- Rigid abduction bracing improves acetabular index in children over six months with minimal complications.
- Pelvic osteotomy offers the most significant improvement in acetabular index but becomes less effective with age.
- Timing and indications for surgery remain unclear, requiring shared decision-making and further research.

## Abstract

Residual acetabular dysplasia (RAD) is a common condition where the acetabulum remains shallow or underdeveloped even after treatment for developmental dysplasia of the hip (DDH). Proper management of RAD is crucial in reducing the risk of hip instability and premature arthritis. This review summarizes the most recent evidence related to the diagnosis and management of RAD in patients during their first decade of life, with an emphasis on data that may inform clinical decision-making and highlight areas in need of further investigation.

Recent studies have shown that rigid abduction bracing significantly improves RAD in patients over six months of age compared to observation only and has minimal treatment complications. Furthermore, bracing has been shown to have a dose-dependent relationship with improvement in acetabular index (AI). Surgical treatment of RAD with pelvic osteotomy significantly improves AI compared to all other treatment approaches, though several studies indicate a reduced effect among older patients. The exact timing and indications for surgical intervention remain controversial.

The management of RAD remains an active area of research, particularly regarding the timing and indications for surgical intervention. Recent studies have demonstrated the effectiveness of rigid abduction bracing for patients with RAD over the age of six months to assist in acetabular remodeling, with a low complication rate. Pelvic osteotomy provides the most significant improvement in AI compared to all other approaches, with some evidence suggesting that these procedures become less effective as patients get older. However, as the timeline for surgical intervention remains unclear, there is a need for shared decision-making when managing RAD, along with additional long-term prospective studies.