The success of management with the Pavlik harness for developmental dysplasia of the hip using a United Kingdom screening programme and ultrasound-guided supervision

Abstract

We present the results of treatment of developmental dysplasia of the hip in infancy with the Pavlik harness using a United Kingdom screening programme with ultrasound-guided supervision. Initially, 128 consecutive hips in 77 patients were reviewed over a 40-month period; 123 of these were finally included in the study. The mean age of the patients at the start of treatment was five weeks (1 to 12). All hips were examined clinically and monitored with ultrasound scanning. Failure of treatment was defined as an inability to maintain reduction with the harness. All hips diagnosed with dysplasia or subluxation but not dislocation were managed successfully in the harness. There were 43 dislocated hips, of which 39 were reducible, but six failed treatment in the harness. There were four dislocated but irreducible hips which all failed treatment in the harness. One hip appeared to be successfully treated in the harness but showed persistent radiological dysplasia at 12 and 24 months. Grade 1 avascular necrosis was identified radiologically in three patients at 12 months.

The Pavlik method

“…Irreducibility has also been reported to be a significant risk factor for failure by several studies [6,18,35].…”

“…A prospective study of USS-monitored Pavlik harness treatment found that success was related to Graf type, with a type 4 more likely to result in failure [34]. Walton et al [35] found a trend of increasing failure with decreasing Graf a angle. They concluded that the most severely affected hips (Graf 4) should be treated as early as possible.…”

Introductory Chapter: Five-Dimensional Approach to the Developmental Dysplasia of the Hip

“…Still, the outcome of nonoperative reduction of dislocated femoral head and its safe containment within the acetabulum strongly depends on timing. If a treatment begins within first 7 weeks, it will be highly successful [32][33][34][35] regardless if one or both hips are treated [36]. That is why meticulous clinical examination of hips in newborns is mandatory for decades.…”

0–6 ay çocuklarda gelişimsel kalça displazisi (GKD) tedavisi

“…[20,21] GKD tedavisinde Pavlik kullanımıyla ilgili yapılan çalışmaların özeti Tablo 1'de verilmiştir. [22][23][24][25][26][27][28] GKD tedavisinde daha az sıklıkla kullanılan Rosen ateli ile ilgili yapılan çalışmalar ise Tablo 2'de özetlenmiştir. [29][30][31][32][33][34] Literatürde Pavlik bandajını diğer tedavi metodlarıyla da karşılaştıran çalışmalar da yapılmıştır.…”