Pavlik Harness treatment may help accelerate development of acetabulum in patients less than 6 months old

Yong Liu et al conducted a study to investigate the impact of failed Pavlik harness (PH) treatment on the outcomes following closed reduction (CR) or open reduction (OR) in developmental dysplasia of the hip (DDH). They found that PH treatment, even if failed, may have the ability of accelerating the development of the acetabulum and increasing the rate of successful CR. Thus the authors advocate a trial of PH treatment for all DDH patients less than 6 months of age.

The primary goal of the treatment in DDH is to achieve a stable and concentric reduction as early as possible so as to facilitate normal development of all structures of the hip while avoiding complications. Failure of PH treatment and late-diagnosed DDH are still commonly encountered. Usually, in these patients, a closed or open reduction is considered for further treatment.

Ninety-three DDH patients treated with CR or OR were enrolled. One group of which received previous PH treatment (F group) and the other (L group) not. The clinical outcomes were evaluated according to McKay's criteria. Radiographs were evaluated for acetabular index (AI) and the degree of dislocation of the hips.

A higher rate of CR was found in F group (P=0.034). Before CR/OR, the mean AI in F group was significantly lower than that in L group (P=0.000), while at the last follow-up, the AIs in both groups were all improved. In F group, there were 7 (16.67%), 18 (42.86%) and 17 (40.48%) hips were classified as Graf type II, III and IV pathologic changes, respectively, when PH treatment started, while the corresponding data were 17 (40.48%), 17 (40.48%) and 8 (19.05%) after PH treatment (P=0.024). At the last follow-up, no significant difference was found concerning the complications between the two groups (P > 0.05).

The authors concluded that - both CR and OR yielded favorable clinical and radiographic outcomes in selected DDH patients. Moreover, even if it failed, PH treatment may have the ability of accelerating the development of the acetabulum and increasing the rate of successful CR. Thus we advocate a trial of PH treatment for all DDH patients less than 6 months of age. Meanwhile, a close monitoring by ultrasonographic examination is required due to the risk of AVN.

Further reading:

Impact of Failed Pavlik Harness Treatment on the Outcomes Following Closed or Open Reduction in Developmental Dysplasia of the Hip, Yong Liu, Lisheng Kan et al, Indian Journal of Orthopaedics (2022) 56:1634–1639 https://doi.org/10.1007/s43465-022-00680-x