The natural history of developmental dysplasia of the hip after early supervised treatment in the Pavlik harness: A prospective, Longitudinal follow-up

Abstract

Between June 1988 and December 1997, we treated 332 babies with 546 dysplastic hips in a Pavlik harness for primary developmental dysplasia of the hip as detected by the selective screening programme in Southampton. Each was managed by a strict protocol including ultrasonic monitoring of treatment in the harness. The group was prospectively studied during a mean period of 6.5 +/- 2.7 years with follow-up of 89.9%. The acetabular index (AI) and centre-edge angle of Wiberg (CEA) were measured on annual radiographs to determine the development of the hip after treatment and were compared with published normal values. The harness failed to reduce 18 hips in 16 patients (15.2% of dislocations, 3.3% of DDH). These required surgical treatment. The development of those hips which were successfully treated in the harness showed no significant difference from the normal values of the AI for the left hips of girls after 18 months of age. Of those dysplastic hips which were successfully reduced in the harness, 2.4% showed persistent significant late dysplasia (CEA <20 degrees) and 0.2% persistent severe late dysplasia (CEA <15 degrees). All could be identified by an abnormal CEA (<20 degrees) at five years of age, and many from the progression of the AI by 18 months. Dysplasia was considered to be sufficient to require innominate osteotomy in five (0.9%). Avascular necrosis was noted in 1% of hips treated in the harness. We conclude that, using our protocol, successful initial treatment of DDH with the Pavlik harness appears to restore the natural development of the hip to normal. We suggest that regular radiological surveillance up to five years of age is a safe and effective practice.

What Is the Impact of Center Variability in a Multicenter International Prospective Observational Study on Developmental Dysplasia of the Hip?

“…Consistent with existing literature, the Pavlik harness was overwhelmingly the favored orthosis across all nonoperative patients [7]; however, each center had a distinct second choice of orthosis. Some studies of limited strength have attempted to examine the efficacy of rigid and soft splint use; however, the results are contradictory and the effect sizes small [15,29].…”

“…Breech presentation occurred more often in younger (\6 months) than in older (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) Conclusions With the lack of strong prognostic indicators for DDH identified to date, the center is an important variable to include as a potential predictor of treatment success or failure.…”

Developmental dysplasia of the hip: What has changed in the last 20 years?

“…Although there are few comparative studies, all the three braces are superior to no treatment. The Craig and the Von Rosen splints might be slightly superior to the Pavlik harness [78] , but the Pavlik harness remains the standard treatment for the majority of children younger than 6 mo as it is the most thoroughly examined, and found to be safe and highly effective, with success rates greater than 90% [79][80][81][82][83] . The function of the frontal leg straps is to flex the hips, and the rear leg straps to prevent adduction of the hips (extreme abduction of the hips should be avoided as this is related to AVN).…”

“…However, some studies raise doubt regarding the necessity of radiographic monitoring [165][166][167] , while others stress its significance [17,48,168] . The incidence of residual acetabular dysplasia after successful treatment with Pavlik harness cannot be disregarded [79,169,170] . Concern has been raised about the late effects of radiation due to the long life expectancy of the patients [171,172] .…”

Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force

“…Because of these methodologic problems, the evidence assessing whether interventions improve functional outcomes is poor, and study details have been excluded. Details about intervention studies [91][92][93][94][95][96][97][98][99][100][101][102][103] that included any assessment of functional outcomes are included in ref 12.…”