What is the role of Pavlik harness in the treatment of developmental dysplasia of the hip (DDH)?

Updated: Feb 26, 2018
  • Author: Junichi Tamai, MD; Chief Editor: William L Jaffe, MD  more...
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Answer

Treatment of DDH begins with careful examination of the newborn. If evidence of instability is present, a Pavlik harness should be considered and, if used, fitted appropriately. [55, 56, 57, 58, 59]

The Pavlik harness should be placed so that the chest strap is at the nipple line, with 2 fingerbreadths of space between chest and strap. The anterior strap is at the midaxillary line and should be set so that the hips are flexed to 100-110º; excessive flexion can lead to femoral nerve compression and inferior dislocations. Quadriceps function should be determined at all clinic visits.

The posterior abduction strap should be at the level of the child's scapula and adjusted to allow comfortable abduction. This should prevent the hips from adducting to the point where the hips dislocate. Excessive abduction should be avoided out of concern regarding the potential development of avascular necrosis. The fitting of the harness should then be checked clinically within the first week and then at regular intervals thereafter. The patient must be carefully monitored to ensure that the harness fits and the hips are reduced.

Ultrasonography is an excellent means of documenting the reduction of the hip in the Pavlik harness and should be performed early in the course of treatment. [60] If the hip is posteriorly subluxated, then the Pavlik harness therapy should be discontinued. [61]

Using the Pavlik harness for guided reduction, which occurs when the hip does not completely reduce initially but is pointed toward the triradiate cartilage, is controversial. When a Pavlik harness is used for guided reduction, the physician should obtain a radiograph after the harness is placed to determine if the femoral heads are pointing toward the triradiate cartilage. An ultrasonogram should be obtained to determine the success, or lack thereof, of the guided reduction.

Several authors have expressed concern that use of the Pavlik harness in patients with bilateral involvement has an increased likelihood of failure. [57, 62] One group compared the success rates of Pavlik harness treatment for unilateral and bilateral frankly dislocated hips in otherwise normal children and found no significant difference. [63]

There is no consensus on the optimal overall duration of Pavlik harness therapy. [64, 65] If the hip is reduced satisfactorily in the harness, the author's practice is to maintain this treatment at least until the hip is considered to be stable both on clinical grounds and on the basis of ultrasonographic findings with the patient out of the brace. Abduction splinting is maintained thereafter if radiographic evidence of residual dysplasia is present.


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