Results of the Pavlik harness when treating Ortolani-positive hips: Predictors of failure and arthrographic findings

Vadillo, Pablo; Encinas-Ullán, Carlos A.; Moraleda, Luis; Albiñana, Javier

doi:10.1007/s11832-015-0666-8

Cited by 20 publications

(31 citation statements)

References 19 publications

(45 reference statements)

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“…The reported failure rates in sonographically pathological hips under the age of three to four weeks were 4% and 7% in two different studies including Graf type IIc and worse hips, 32 , 48 whereas they stood at 20% and 37% in two other studies including only dislocated hips. 28 , 43 A considerable increase in the failure rate of Pavlik’s method was noted in infants older than three weeks with highly dislocated hips. 28 A treatment initiation age of seven weeks and older was considered a risk for failure in two studies.…”

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%

“…Accompanying risk factors for DDH including post-natal swaddling history, multigravida and foot deformities were considered to increase the risk for failure. 37 , 43 Full-term babies had a tendency to fail Pavlik’s method. 47 …”

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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“…is more problematic and has had Pavlik harness failure in 21% to 37% of patients. 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.…”

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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“…62 Risk factors for failure are: irreducible hip with Ortolani manoeuvre; inverted labrum; high β angle; insufficient coverture of the head; acetabular index >36°; and bilateral dislocation. 61,63,64…”

Section: Treatmentmentioning

confidence: 99%

Developmental dysplasia of the hip: update of management

et al. 2019

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The term ‘developmental dysplasia of the hip’ (DDH) includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip. DDH alters hip biomechanics, overloading the articular cartilage and leading to early osteoarthritis. DDH is the main cause of total hip replacement in young people (about 21% to 29%). Development of the acetabular cavity is determined by the presence of a concentrically reduced femoral head. Hip subluxation or dislocation in a child will cause an inadequate development of the acetabulum during the remaining growth. Clinical screening (instability manoeuvres) should be done universally as a part of the physical examination of the newborn. After two or three months of life, limited hip abduction is the most important clinical sign. Selective ultrasound screening should be performed in any child with abnormal physical examination or in those with high-risk factors (breech presentation and positive family history). Universal ultrasound screening has not demonstrated its utility in diminishing the incidence of late dysplasia. Almost 90% of patients with mild hip instability at birth are resolved spontaneously within the first eight weeks and 96% of pathologic changes observed in echography are resolved spontaneously within the first six weeks of life. However, an Ortolani-positive hip requires immediate treatment. When the hip is dislocated or subluxated, a concentric and stable reduction without forceful abduction needs to be obtained by closed or open means. Pavlik harness is usually the first line of treatment under the age of six months. Hip arthrogram is useful for guiding the decision of performing a closed or open reduction when needed. Acetabular dysplasia improves in the majority due to the stimulus provoked by hip reduction. The best parameter to predict persistent acetabular dysplasia at maturity is the evolution of the acetabular index. Pelvic or femoral osteotomies should be performed when residual acetabular dysplasia is present or in older children when a spontaneous correction after hip reduction is not expected. Avascular necrosis is the most serious complication and is related to: an excessive abduction of the hip; a force closed reduction when obstacles for reduction are present; a maintained dislocated hip within the harness or spica cast; and a surgical open reduction.Cite this article: EFORT Open Rev 2019;4:548-556. DOI: 10.1302/2058-5241.4.180019

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Results of the Pavlik harness when treating Ortolani-positive hips: Predictors of failure and arthrographic findings

Cited by 20 publications

References 19 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

Developmental dysplasia of the hip: update of management

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