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Long-term Results of Developmental Hip Dysplasia Under Therapy With Pavlik Harness
Manuel Gahleitner1, Lorenz Pisecky1, Tobias Gotterbarm1
1Departments of Orthopedics and Traumatology.
Insights
The Pavlik harness effectively treats developmental dysplasia of the hip (DDH) in infants, showing excellent long-term results with minimal residual dysplasia. This conservative treatment ensures satisfactory clinical and radiological outcomes for DDH patients.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip Treatment
Background:
- Developmental dysplasia of the hip (DDH) is a condition requiring effective treatment in infancy.
- The Pavlik harness is a standard conservative method for treating DDH, particularly Graf types IIc or worse.
- Long-term outcomes of Pavlik harness treatment for DDH are crucial for understanding its lasting efficacy.
Purpose of the Study:
- To evaluate the long-term clinical and radiological outcomes of developmental dysplasia of the hip (DDH) treated with the Pavlik harness.
- To assess the rate of residual dysplasia and functional hip status after more than two decades of follow-up.
Main Methods:
- A cohort of 152 infants with DDH (Graf type IIc or worse) treated with Pavlik harness between 1995-2006 was followed for over 20 years.
- Clinical evaluation included standardized hip scores (Oxford, Schulthess, Harris).
- Radiological assessment involved Wiberg center-edge angle, Severin classification, Reimers migration percentage, and Sharp angle measurements.
Main Results:
- Follow-up was achieved in 60 patients (39.5%) with 80 affected hips after a mean of 20.46 years.
- Only 2 patients (3.77%) showed slight residual dysplasia on Severin's classification; 4 patients had residual dysplasia by Sharp angle.
- No avascular necrosis was observed, and clinical outcomes were highly satisfactory with no significant pain or functional limitation reported.
Conclusions:
- Conservative treatment of DDH (Graf types IIc, D, III) using the Pavlik harness demonstrates excellent long-term therapeutic success.
- The study reports a very low rate of residual dysplasia (2.81%) and highly satisfactory radiological and clinical outcomes.
- The Pavlik harness is a safe and effective treatment for DDH, providing durable results into adulthood.
Introduction:
The Pavlik harness is a commonly used treatment for developmental dysplasia of the hip (DDH) of types IIc or worse, based on the Graf classification. This study aimed to assess the long-term follow-up outcomes after treating DDH with the Pavlik harness.
Methods:
Between 1995 and 2006, ultrasound screening was conducted on 7372 newborns within the first days of life. Among them, 203 dysplastic hips in 152 patients, whose sonograms were Graf type IIc or worse, were treated with Pavlik harness. Treatment was discontinued if the measurement indicated Graf type Ia/b. More than 20 years later (mean: 20.46 y), patients were invited for clinical evaluation (Oxford Hips Score, Schulthess Hip Score, Harris Hip Score) and radiologic examination (center-edge angle according to Wiberg and the Severis classification, the rate of roofing of the femoral head via the Reimers migration percentage, and the Sharp angle).
Results:
Of the 152 patients, 60 (39.5%) participants with 80 (39.4%) affected hips (57.7% type IIc, 7.9% type D, and 15.6% type IIIa/b) were reexamined. The average follow-up duration was 20.5 years, with a maximum of 25.9 years. According to the Severin's classification, only 2 (3.77%) patients, each with one affected hip, showed slight residual dysplasia. The Reimer's migration percentage indicated an average of almost 90% canopy cover in the patient collective studied. No avascular necrosis was found, and the Sharp angle showed an average of almost 38 degrees. Only 4 participants with each one affected hip showed residual dysplasia according to the Sharp angle. The clinical results were quite satisfying, as none of the patients experienced hip pain that significantly limited their everyday activities or sports engagement, requiring medical attention before this study.Conclusions:Conservative therapy of DDH (Graf type IIc, D, III) with the Pavlik harness has demonstrated very good therapeutic success and a very low rate of residual dysplasia (2.81%). Both the radiologic and clinical outcomes were highly satisfactory.
Level Of Evidence:
Level IV.
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