Pavlik Harness Disease Revisited: Does Prolonged Treatment Of A Dislocated Hip In A Harness Adversely Affect The Αangle?

Keywords

alpha angle; DDH; developmental dysplasia of the hip; hip dysplasia; Pavlik harness; Pavlik harness disease

Abstract

Background: Current dogma contends that prolonged treatment of a dislocated hip in Pavlik harness beyond 3 weeks will cause "Pavlik harness disease." To our knowledge, however, no previous studies have documented objective morphologic changes to the acetabulum from continued treatment of a persistently dislocated hip. Methods: We retrospectively reviewed a consecutive series of infants with developmental dysplasia of the hip, below 6 months old, who failed Pavlik treatment from a single, tertiary-care pediatric hospital and a multicenter, international study group. Inclusion criteria were dislocated hips confirmed by ultrasound (both initially and at Pavlik termination) and a minimum of 2 ultrasounds during harness treatment at least 3 weeks apart. As a global measure of acetabular morphology, αangle (AA) was compared between initial and final ultrasound. The final means of obtaining successful hip reduction was recorded from the medical records. Results: Forty-nine hips in 38 patients were identified. Median age at Pavlik initiation was 4 weeks (range, 0 to 18 wk); median time in harness was 6 weeks (range, 3 to 14 wk). Surprisingly, a mean of 4 degrees improvement in AA (95% CI, 2-6 degrees; P=0.001) was observed between first and final ultrasound. We found no difference in AA change between those in harness 3 to 5 weeks and those with prolonged wear >5 weeks (P=0.817). There was no significant association between change in AA and time in harness (P=0.545), age at Pavlik initiation (P=0.199), clinical reducibility of the hip (P=0.202), or initial percent femoral head coverage (P=0.956). Following harness failure, 22/49 hips (45%) were successfully treated with rigid abduction bracing, 16 (33%) by closed reduction/spica casting, and 10 (20%) by open reduction; 1 hip (2%) spontaneously reduced and required no further treatment. Conclusions: On the basis of the lengths of harness treatment in our series, most hips did not exhibit negative changes in the acetabular AA in response to prolonged treatment of a dislocated hip in harness. Furthermore, 80% of hips failing Pavlik treatment were successfully reduced through closed means, indicating that subsequent treatment was not compromised.

Publication Date

1-1-2018

Publication Title

Journal of Pediatric Orthopaedics

Volume

38

Issue

6

Number of Pages

297-304

Document Type

Article

Personal Identifier

scopus

DOI Link

https://doi.org/10.1097/BPO.0000000000000818

Socpus ID

85048668515 (Scopus)

Source API URL

https://api.elsevier.com/content/abstract/scopus_id/85048668515

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