Developmental hip dysplasia potentiated by inappropriate use of the Pavlik harness

Nineteen patients with 28 dislocated hips treated in a Pavlik harness for > 8 weeks with no evidence of hip reduction were identified. After discontinuation of the harness use, reduction was often difficult to obtain and maintain. Thirteen of these patients (17 hips) required operative intervention to obtain stable located hips. In this group of patients, we attempted to identify factors that led to an unusually high number of failures of closed management techniques. Prolonged positioning of the dislocated hip in flexion and abduction potentiates dysplasia, particularly of the posterolateral acetabulum, and increases the difficulty of obtaining a stable closed reduction. Confirmation of satisfactory reduction during treatment with the Pavlik harness is mandatory. Such treatment should be discontinued promptly if reduction is unobtainable.