Related Experiment Video
Updated: Dec 28, 2025
Author Spotlight: A Novel 3D-Printed Titanium Implant for Minimally Invasive Treatment of Hip Dysplasia in Young Dogs
Published on: April 19, 2024
Expert-Based Consensus on the Principles of Pavlik Harness Management of Developmental Dysplasia of the Hip
S P Kelley1,2, M M Feeney1, C L Maddock1
1The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
This study established expert consensus on Pavlik harness management for developmental dysplasia of the hip (DDH). The findings provide standardized principles to improve treatment and outcomes for this common newborn orthopaedic condition.
Area of Science:
- Orthopaedics
- Paediatric Medicine
- Medical Consensus Studies
Background:
- Developmental dysplasia of the hip (DDH) is the most common congenital orthopaedic disorder.
- The Pavlik harness is a primary treatment, but clinical practice shows significant variability.
- Lack of standardized protocols hinders effective teaching and outcome comparison.
Purpose of the Study:
- To achieve international expert consensus on optimal Pavlik harness management for DDH.
- To address the variability in current treatment parameters.
- To develop standardized principles for clinical practice.
Main Methods:
- Literature review to identify key treatment items.
- Delphi methodology with International Hip Dysplasia Institute experts.
- Iterative surveying and feedback until statistical consensus was reached.
Main Results:
- Consensus achieved after four rounds of surveying.
- Developed 28 management principles in 8 categories, presented in simplified tables.
- Identified controversial areas in DDH nonoperative management for future research.
Conclusions:
- A comprehensive set of expert-endorsed principles for Pavlik harness management of DDH was created.
- The consensus provides a foundation for standardized clinical practice and education.
- Further research into controversial aspects of DDH management is recommended.
Abstract:
Developmental dysplasia of the hip (DDH) is the most common orthopaedic disorder in newborns. While the Pavlik harness is one of the most frequently used treatments for DDH, there is immense variability in treatment parameters reported in the literature and in clinical practice, leading to difficulties in standardizing teaching and comparing outcomes. In the absence of definitive quantitative evidence for the optimal Pavlik harness management strategy for DDH, we addressed this problem by obtaining international expert-based consensus on the subject.
Methods:
An initial list of items relevant to Pavlik harness treatment was derived by a review of the literature. Delphi methodology was used to guide serial rounds of surveying and obtaining feedback from content matter experts from the International Hip Dysplasia Institute (IHDI), which continued in the same manner until consensus based on standard statistical analysis was reached. This was followed by a corroboration of face validity to derive the final set of management principles.
Results:
Four rounds of structured surveying were required to reach consensus. Following 2 rounds of peer review, and from an initial list of 66 items in 8 categories, we were able to derive 2 simplified, yet comprehensive, print-friendly tables consisting of 28 items in 8 categories to assist clinicians in managing DDH with a Pavlik harness. The tables contain principles of treatment initiation, application and follow-up of the harness, complications, weaning, and end-of-treatment decision-making as well as specific criteria based on the severity of the DDH. Furthermore, highly contentious items were identified as important areas of future study.
Conclusions:
We developed a comprehensive set of principles based on expert consensus to assist clinicians in the management of DDH using the Pavlik harness. This study also generated a list of the most controversial areas in the nonoperative management of DDH, which should be considered high priority for future study to further refine and optimize outcomes.
Level Of Evidence:
Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
