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Topic:

Developmental Dysplasia of the Hip

Issue:

Hip

Category:

Developmental

Title:

Reapplication of the Pavlik Harness for Treatment of Developmental Dysplasia of the Hip After Initial Pavlik Harness Failure

Author:

Tomaru, Yohei MD; Kamegaya, Makoto MD; Saisu, Takashi MD; Murakami, Reiko MD; Sakuma, Akitoshi MD; Oikawa, Yasuhiro MD; Kakizaki, Jun MD; Segawa, Yuko MD; Tsukagoshi, Yuta MD; Kamada, Hiroshi MD; Yamazaki, Masashi MD

Journal:

Journal of Pediatric Orthopaedics

Date:

February 2024

Reference:

44(2): p 69-75, DOI: 10.1097/BPO.0000000000002572

Level Of Evidence:

​

# of Patients:

56 patients (57 hips)

Study Type:

Retrospective cohort study

Location:

Not specified

Summary:

This study investigates the effectiveness of reapplying the Pavlik Harness (PH) for treating developmental dysplasia of the hip (DDH) after the initial failure of PH. The results showed a 49% reduction rate and a low rate of avascular necrosis (AVN), indicating that reapplication of PH could be a viable alternative for failed treatment.

Methods:

Included patients with DDH who underwent reapplication of the PH between 1988 and 2012. Follow-up was conducted for at least 5 years. Factors analyzed included age, sex, hip side, and the presence of the Ortolani sign. At the final follow-up, hip development was assessed using the Severin classification, and AVN was evaluated using the Kalamchi classification and the Salter criteria.

Exclusions:

Patients with follow-up less than 5 years were excluded.

Results:

Mean age at first PH application: 4.2 months; mean age at second PH application: 5.8 months. Reduction rate: 49% (28 out of 57 hips). AVN rate in reduced hips: 3.6% (1 out of 28 hips). Severin classification: 27 hips in class I, 1 hip in class III. A higher proportion of left-side hip dislocations (85%) were successfully reduced (P<0.001). The Ortolani sign was positive in 61% of successful reductions vs. 38% of failures (P=0.06).

Conclusions:

Reapplication of the Pavlik Harness demonstrated a 49% reduction rate with a low AVN rate (3.6%). It may be particularly effective for left-side dislocations and in cases with a positive Ortolani sign. This method could be considered in patients who fail initial PH treatment.

Relevance:

Limitations:

Perspective:

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