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Pavlik harness and Frejka pillow: compliance affects results of outpatient treatment
Michal Zídka1,2, Valér Džupa3
1Department of Orthopaedics, CLPA-Mediterra, Sokolovská 304, 190 61, Prague 9, Czech Republic. michal.zidka@mediterra.cz.
Insights
This study found that both the Frejka pillow and Pavlik harness are equally effective for treating infant hip dysplasia. Parental compliance, however, was better with the Frejka pillow, highlighting the importance of parental involvement in treatment decisions.
Area of Science:
- Pediatric Orthopedics
- Developmental Biology
Background:
- Outpatient treatment of hip dysplasia in newborns yields excellent results.
- General screening combined with early treatment using functional abduction devices is effective.
- The Frejka pillow and Pavlik harness are common treatment devices in many regions.
Purpose of the Study:
- To compare the efficiency and duration of treatment for hip dysplasia using the Frejka pillow versus the Pavlik harness.
- To determine if the choice of abduction device influences parental compliance with the treatment protocol.
Main Methods:
- Analysis of data from 286 infants diagnosed with hip dysplasia in early life via clinical and sonographic screening.
- Treatment device selection (Frejka pillow for 145 infants, Pavlik harness for 137) was based on clinical findings, sonographic severity (Graf classification), and parental cooperation.
- Documentation of treatment duration and follow-up loss rates for each device.
Main Results:
- Overall outpatient treatment success rate was 98.6%.
- No significant difference in treatment duration or efficiency between the Frejka pillow and Pavlik harness for comparable pathologies.
- Statistically significant greater parental non-compliance observed with the Pavlik harness (p=0.0279, OR=2.7).
Conclusions:
- Both Frejka pillow and Pavlik harness demonstrate comparable treatment efficiency for infant hip dysplasia.
- Parental cooperation is a critical factor in successful screening and treatment.
- Informed parental consent and consideration of comfort during nursing care are essential for treatment compliance.
Purpose Of The Study:
Outpatient treatment of hip dysplasia in newborns has excellent results. A combination of general screening with early treatment with a functional abduction device works well. Treatment with the Frejka pillow and the Pavlik harness is frequently used in our region. The aim of the study is to compare efficiency and treatment duration, related to the brace used, and to prove that the choice of an abduction device implies parental compliance with the treatment protocol.
Materials And Methods:
Data of 286 treated children were analyzed. The diagnosis was made in the first weeks of life by clinical and sonographic examinations during general screening. The choice of treatment device was expert dependent and was involved by many variables. The experience, type of clinical finding and sonographic pathology according to Graf, availability of a treating facility, and the potential cooperation of individual parents were major parameters. The Frejka pillow was used to treat 145 children and the Pavlik harness was used in 137 children. The treatment duration and percentage of infants lost from follow-up in relation to the device used was documented.
Results:
The success rate of outpatient treatment was 98.6%. In six patients, the type of device had to be changed during the treatment period. Physiological sonographic findings were achieved in all hips by the end of the treatment. The Frejka pillow was used as the preferred device in milder stable dysplastic hips, while unstable and decentered hips were treated more frequently with the Pavlik harness. Treatment lasted, on average, 95 days and 119 days in the Frejka and in the Pavlik group, respectively; there was no statistical significance in treatment duration of comparable sonographic pathologies. We observed statistically greater parental non-compliance with the treatment protocol in the Pavlik harness group (p = 0.0279; OR 2.7; 95% CI 1.07; 8.5).
Conclusions:
Neither of the abduction devices was inferior with regard to treatment efficiency. We found that parental cooperation was an important factor during screening and treatment. The treatment decision and the choice of the brace must be made with full consent of the parents, keeping in mind that comfort during the nursing care may have a significant influence on compliance with the treatment protocol.
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