Parent-Derived Health State Utilities for Developmental Dysplasia of the Hip

Background: Developmental hip dysplasia (DDH) is a common condition associated with pain, disability and early hip osteoarthritis when untreated. Health utility scores have not previously been defined for a comprehensive set of DDH health states. The purpose of this study was to establish utility scores associated with DDH health states.

Methods: Patients treated for DDH using either Pavlik harness or abduction bracing and closed/open hip reduction between February 2016 and March 2023 were identified. Thirteen vignettes describing health states in the DDH life cycle were developed. Parents of patients were asked to score each state from 0 to 100 using the feeling thermometer. A score of "0" represents the worst state imaginable/death and a score of "100" represents perfect health. Utility scores were calculated and compared between parents of patients treated operatively and nonoperatively.

Results: Ninety parents of children with DDH (45 operative, 45 nonoperative) were enrolled. There were 82 (91.1%) female children (median age of 4.9 years at enrollment). Median utility scores ranged from 77.5 [interquartile range (IQR): 70.0 to 90.0] for Pavlik harness and 80.0 (IQR: 60.0 to 86.3) for abduction bracing to 40.0 (IQR: 20.0 to 60.0) for reduction/spica cast and 40.0 (IQR: 20.0 to 50.0) for end-stage hip arthritis. Utility scores were lower in the operative group for Pavlik harness (median 70.0 vs. 80.0, P <0.01), end-stage arthritis (30.0 vs. 40.0, P =0.04), and 1 year after total hip arthroplasty (85.0 vs. 90.0, P =0.03) health states compared with the nonoperative group. There were no differences in other scores.

Conclusions: Thirteen health states related to the life cycle of DDH were collected. Nonoperative interventions for DDH were viewed by parents slightly more favorably than operative treatments or long-term sequelae of untreated DDH. Future studies can assess other potential treatment experiences for patients with DDH or use these scores to perform cost-effectiveness analysis of different screening techniques for DDH.

Level of evidence: Level III.