Results of Pavlik Harness Treatment for Neonatal Hip Dislocation as Related to Graf's Sonographic Classification

Mostert, Adriaan K.; Tulp, Niek J. A.; Castelein, René M.

doi:10.1097/01241398-200005000-00007

Cited by 37 publications

(54 citation statements)

References 17 publications

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“…The reported success rate of Pavlik harness treatment in Graf Type III and IV hips is not as high as the other Graf hip types [3,16,21,22,25,31]. The results of the present study revealed that both a lower initial a angle and a worse Graf hip type decrease the Pavlik harness treatment success rate.…”

Section: Discussioncontrasting

confidence: 59%

“…Besides, adductor muscles adversely influence the reduction of a highly dislocated hip while the hip is in flexion and abduction in a Pavlik harness and a higher success rate of treatment should not be expected in such a hip [2,12,23]. These pathoanatomical differences explain the greater difficulty to succeed in dislocated hips [16]. In a comparative study, better ultrasonographic outcome and lesser secondary treatment need were achieved by von Rosen splint treatment than by Pavlik harness treatment in Graf Types III and IV hips under the age of 4 months [32].…”

Section: Discussionmentioning

confidence: 99%

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Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip

Ömeroğlu

Köse

Akceylan

2016

Clinical Orthopaedics &Amp; Related Research

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Background Treatment of developmental dysplasia of the hip (DDH) using the Pavlik harness has been a widely used method in patients between 0 and 6 months of age for many years. However, the factors influencing the success rate of this treatment modality have still not exactly been determined as a result of the limited number of clinical studies with higher level of evidence. Questions/purposes We, therefore, asked whether (1) patient-related variables such as age, gender, and laterality; coexisting risk factors including family history, breech presentation, intrauterine packing, first-born girl, oligohydroamnios, and swaddling; and (2) the severity of hip dysplasia, defined by ultrasonography, are associated with differences in the success rate of Pavlik harness treatment in infants with DDH. Methods Between 2012 and 2014, we treated 153 children (B 6 months of age) with DDH using the Pavlik harness. Hip dysplasia apart from coexisting neuromuscular disorders, congenital abnormalities, or syndromes was our inclusion criteria. Of patients thus treated, 130 (85%) were available for the evaluation of patient-and hip-related variables against the success of Pavlik harness treatment. Mean age of these patients on day of diagnosis and initiation of treatment was 108 days. The diagnostic and followup examinations of the hips were made by ultrasonography using Graf's method. Pavlik harness treatment was initiated in Graf Type IIa-and worse hips and treatment was considered ''successful'' when a Graf Type I hip was achieved. Pavlik harness treatment was successful in 92 (71%) patients (130 of 181 hips [72%]). Results Age was the only patient-related variable influencing the success rate of the treatment; the mean age of children in whom Pavlik harness treatment succeeded (97 ± 38 days; 95% confidence interval [CI], 90-112) was lower than the age of those who failed (135 ± 37 days; 95% CI, 123-147; p \ 0.001). The highest success rate was obtained in children younger than age 3 months (37 of 40 [93%]) and the lowest one older than age 5 months (nine of 24 [37%]) (p \ 0.001). The threshold age value related to an increased risk of failure was found to be 4 months and older, which had a sensitivity of 66% and a specificity of 77% (p \ 0.001). A higher initial a angle was observed in the hips in which the treatment succeeded (53°± 6°; 95% CI, 51°-53°) than in those that failed (47°± 7°; 95% CI, 45°-

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Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip

Ömeroğlu

Köse

Akceylan

2016

Clinical Orthopaedics &Amp; Related Research

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“…The success rate of Pavlik harness treatment is reported to be between 80 and 97% [2,9,11,18,21]. We achieved hip reduction with the Pavlik harness in 18 out of 31 hips.…”

Section: Discussionmentioning

confidence: 74%

“…Mostert et al reported Pavlik harness treatment to be effective in 97% of Graf type III and in 50% of Graf type IV hips, and due to the lower success rate in Graf type IV hips they recommend alternative treatment for patients with this condition [11]. Suzuki et al [17,18] suggested that dislocation of the femoral head reduces the success of the Pavlik harness.…”

Section: Discussionmentioning

confidence: 99%

Indicators of successful use of the Pavlik harness in infants with developmental dysplasia of the hip

Atalar

Şaylı

Yavuz

et al. 2006

International Orthopaedics (SICOT)

103

111

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“…Greater than 90% success may be expected in hips that are stable on examination but dysplastic on ultrasound images [8] and for those dislocatable with the Barlow [3] maneuver [6,12,14,25]. However, treatment failures of 30% to 60% have been reported in dislocated reducible Ortolani-positive hips [2,14,16,19,20,24,[30][31][32]. Failure of the Pavlik harness method has been associated with an increased risk of osteonecrosis of the femoral head [29].…”

Section: Introductionmentioning

confidence: 99%

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

Novais

Kestel

Carry

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Results of Pavlik Harness Treatment for Neonatal Hip Dislocation as Related to Graf's Sonographic Classification

Cited by 37 publications

References 17 publications

Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip

Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip

Indicators of successful use of the Pavlik harness in infants with developmental dysplasia of the hip

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

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