Higher Pavlik Harness Treatment Failure Is Seen in Graf Type IV Ortolani-positive Hips in Males

Novais, Eduardo N.; Kestel, Lauryn; Carry, Patrick M.; Meyers, Mariana L.

doi:10.1007/s11999-016-4776-5

Cited by 52 publications

(51 citation statements)

References 34 publications

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“…Male gender was considered a significant risk factor correlated with the failure of Pavlik’s method in two studies. 36 , 52 In one study, 93% of the male patients treated with the Pavlik harness at a mean age of seven weeks needed other treatment modalities. 52 Besides, the treatment duration was found to be somewhat longer in male than in female patients.…”

Section: Results Of Treatmentmentioning

confidence: 99%

“… 10 , 24 , 27 , 34 , 35 , 37 – 39 , 42 , 45 , 46 , 48 Besides, the risk of failure in Graf type IV hips was found to be about four times higher than in Graf type III hips. 36 It is evident that the Graf type IV hip has the highest rate of failure among the hip types in Graf’s classification system. Besides, an alpha angle of less than 47° (sensitivity 47%, specificity 86%) was found to be the threshold value for the failure in Pavlik’s method.…”

Section: Results Of Treatmentmentioning

confidence: 99%

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Treatment of developmental dysplasia of the hip with the Pavlik harness in children under six months of age: Indications, results and failures

Ömeroğlu

2018

Journal of Children's Orthopaedics

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PurposeThe aim of this article is to review the current concepts in the indications, results and failure causes of the treatment of developmental dysplasia of the hip (DDH) with the Pavlik harness.Methods:The reported variables influencing the outcome in the Pavlik harness treatment were analyzed.ResultsSignificant discrepancies about the clinical and radiological outcomes, the rates of failure and complications as well as the variables influencing the treatment outcome occur in the published studies due to the heterogeneity of the data and the differences in the methods used. The overall short-, mid- or long-term success rate of the treatment ranges from 45% to 100% and it is commonly over 75%. The rate of osteonecrosis of the femoral head ranges from 1% to 30%. Age, gender, laterality, radiological or clinical severity of the initial hip pathology and parents’ compliance are the commonly reported determinants of failure of the treatment.ConclusionThe failure in treatment with the Pavlik harness is multifactorial, initial type of hip dysplasia being the most prominent followed by the treatment initiation age. This type of treatment cannot be considered as the best option in Graf IV hips (hip ultrasonography) or highly dislocated hips (plain radiography) and in infants older than three months of age, as the risk of failure and development of complications including osteonecrosis and femoral nerve palsy seem to increase in such circumstances. Large-scale, comparative studies including homogenous data are needed to answer the unsolved questions concerning indications.

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Section: Results Of Treatmentmentioning

confidence: 99%

Section: Results Of Treatmentmentioning

confidence: 99%

Treatment of developmental dysplasia of the hip with the Pavlik harness in children under six months of age: Indications, results and failures

Ömeroğlu

2018

Journal of Children's Orthopaedics

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“…23 -25 Patient-related risk factors for failure of harness treatment included increased age at initiation of treatment (>7 weeks old), 25,26 multigravida birth, 27 the presence of a foot deformity, 27 and male sex. 24 The initial ultrasonographic severity of dysplasia in the Ortolani-positive hip is prognostic for the failure of Pavlik harness treatment, with more severely dislocated hips in which the labrum is interposed between the femoral head and acetabulum being associated with failure. 23 For those patients with an Ortolanipositive hip who fail to stabilize after initial Pavlik harness treatment, authors of recent literature suggest that a trial of a more rigid abduction hip orthosis, such as an Ilfeld orthosis (Fig 6)…”

Section: Figurementioning

confidence: 99%

Developmental Dysplasia of the Hip

et al. 2019

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Pediatricians are often the first to identify developmental dysplasia of the hip (DDH) and direct subsequent appropriate treatment. The general treatment principle of DDH is to obtain and maintain a concentric reduction of the femoral head in the acetabulum. Achieving this goal can range from less-invasive bracing treatments to more-invasive surgical treatment depending on the age and complexity of the dysplasia. In this review, we summarize the current trends and treatment principles in the diagnosis and treatment of DDH.

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“…Selecting these devices for the treatment of an unstable hip, especially a resting-dislocated (Ortolani) hip, may impose some risk on acetabular development and treatment outcome. Novais et al reported that Pavlik harness treatment failed in 27% of Ortolani-positive hips, compared with 8% of stable dysplastic hips and 5% of Barlow-positive hips [7]. High failure rates of the Pavlik harness in dislocated hips have been reported by other authors as well [8].…”

Section: Discussionmentioning

confidence: 85%

Instability Testing for Congenital Hip Dislocation: Knee Extension Provokes Hip Dislocation

Samelis

2020

Cureus

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The classic Ortolani and Barlow signs are routinely used to diagnose hip instability secondary to severe acetabular dysplasia in the newborn. However, eliciting a positive sign depends largely on the experience of the examiner and the subjective amount of manual pressure the examiner applies on the baby's hips. Furthermore, these signs do not give a clue for the selection of a maturation or immobilization device after reduction of an unstable hip: belowknee hip spica, above-knee hip spica or a Pavlik harness. The aim of this study is to describe a clinical sign that could be useful in detecting hip instability of the newborn and to decide the proper treatment in a more objective manner: knee extension provokes dislocation of the ipsilateral unstable hip.

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Higher Pavlik Harness Treatment Failure Is Seen in Graf Type IV Ortolani-positive Hips in Males

Cited by 52 publications

References 34 publications

Treatment of developmental dysplasia of the hip with the Pavlik harness in children under six months of age: Indications, results and failures

Treatment of developmental dysplasia of the hip with the Pavlik harness in children under six months of age: Indications, results and failures

Developmental Dysplasia of the Hip

Instability Testing for Congenital Hip Dislocation: Knee Extension Provokes Hip Dislocation

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