Indicators of successful use of the Pavlik harness in infants with developmental dysplasia of the hip

Abstract

This study examined the outcomes of ultrasound-monitored Pavlik harness treatment in 25 infants (2 boys and 23 girls) representing a total of 31 cases of developmental dysplasia of the hip of Graf type IIc or more severe. For all infants, Pavlik harness treatment started after ultrasonographic diagnosis in our clinic. If there was no improvement by the third week of follow-up, the harness treatment was discontinued. Of the 25 patients (31 hips), 16 patients (18 hips) were successfully treated with the Pavlik harness. The effects of age at start of treatment, gender, side of pathology, first clinical evaluation findings, bilaterality, and Graf type on Pavlik harness treatment success were analysed. We found that the outcome of treatment with the Pavlik harness was related to Graf type, age at start of treatment, and bilaterality.

Figures

Fig. 1

An important advantage of the Pavlik harness is the ability to monitor hip joint reduction by ultrasound when the harness is in place

Fig. 2

Relationship between age (in weeks) and treatment success: infants aged 7 weeks and under had a higher rate of success than those aged 8 weeks and over

Fig. 3

The effects of Graf type on treatment results. Infants with type IIc, IId or III hips had a higher rate of treatment success than infants with type IV hips

Fig. 4

Relationship between bilaterality and treatment success: patients with bilateral DDH were found to have a lower rate of treatment success than patients who had DDH on only one side

Fig. 5

This pre-treatment ultrasound image of the hip in a 5-week-old infant is consistent with Graf type IV. Hip joint reduction could not be achieved after 3 weeks of Pavlik harness treatment (Patient ID 21)