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

Abstract

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.

Efficacy of closed reduction for developmental dysplasia of the hip: midterm outcomes and risk factors associated with treatment failure and avascular necrosis

“…Our results showed the orthosis treatment did not affected the CR results. However, this points should be further discussed in further studies, because the failure of orthosis treatment for DDH in infants may involve many variables, especially the compliance to the standard treatment regimen, and these patient-related variables lead to the bias outcomes [30] .…”

Efficacy of closed reduction for developmental dysplasia of the hip: midterm outcomes and risk factors associated with treatment failure and avascular necrosis

“…Our results showed the orthoses treatment did not affected the CR results. However, this points should be further discussed in further studies, because the failure of orthoses treatment for DDH in infants may involve many variables, especially the compliance to the standard treatment regimen, and these patientrelated variables lead to the bias outcomes [32] .…”

Efficacy of closed reduction for developmental dysplasia of the hip: midterm outcomes and risk factors associated with treatment failure and avascular necrosis

“…Our results showed the orthoses treatment did not affected the CR results. However, this points should be further discussed in further studies, because the failure of orthoses treatment for DDH in infants may involve many variables, especially the compliance to the standard treatment regimen, and these patientrelated variables lead to the bias outcomes [35] .…”