Use of the Pavlik harness for hip displacements. When to abandon treatment

Seven hundred twenty congenitally dislocated or subluxated hips in 550 patients less than one year old, treated with the Pavlik harness, were retrospectively reviewed. Overall, 11% of the hips proved irreducible by Pavlik harness treatment, 9% had dysplasia at the end of harness treatment, and 5% developed dysplasia by the age of two years two months (average). Fourteen percent of the hips positive for Ortolani's sign, 6% of the hips positive for Barlow's sign, and 2% of the congenitally subluxated hips required open or closed reduction followed by plaster hip spica immobilization. Avascular necrosis occurred in 0.7% of the hips treated with the Pavlik harness alone. Transient irritability with pain and limited motion of the hip occurred in 1% of the hips. The Pavlik harness is not appropriate for the larger child, most children older than eight months of age, the child in whom the examiner does not get an adequate sense of reduction, the hip that redislocates with the slightest adduction, and the hip that requires excessive flexion to maintain reduction. Pavlik harness treatment should be abandoned in favor of other methods if, after two to four weeks of use, abduction has not improved sufficiently to allow reduction, the hip has not reduced, or the hip remains unstable.