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Failure of Pavlik Harness Treatment in Infants Under 6 Months Old with Dislocated Hips: Short- and Intermediate-Term
Ahmet Imerci1,2, Mihir M Thacker1, James Richard Bowen1
1Department of Orthopaedic Surgery, Nemours Children's Health, Delaware, 1600 Rockland Rd., Wilmington, DE 19803 USA.
Insights
Most infants failing Pavlik harness therapy for hip dislocation can be successfully treated with closed reduction or bracing. Delayed Pavlik treatment initiation increases the need for surgery.
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
Background:
- Pavlik harness therapy is a common initial treatment for infantile hip dislocation.
- Failure of Pavlik harness therapy necessitates alternative treatment strategies.
Purpose of the Study:
- To evaluate the outcomes of infants with hip dislocation who failed initial Pavlik harness therapy.
- To compare the effectiveness of brace, closed reduction (CR), and open reduction (OR) in this patient group.
Main Methods:
- Retrospective review of 50 infants (66 hips) treated between 2000 and 2018 after Pavlik harness failure.
- Treatments included rigid abduction splint, CR, or OR before 6 months of age.
- Data collected on demographics, treatment course, and complications.
Main Results:
- Closed treatment was successful in most cases.
- Delayed Pavlik harness initiation (after 3 weeks) and unilateral dislocations were associated with increased need for operating room procedures.
- Open reduction was linked to avascular necrosis, but not dysplasia or re-dislocation.
Conclusions:
- Closed treatment modalities are effective for hip dislocations that do not respond to Pavlik harness therapy.
- Early initiation of Pavlik harness therapy is crucial to potentially avoid surgical intervention.
Objective:
This study aimed to determine the short- and medium-term outcomes of hip dislocation in infants who failed Pavlik harness therapy and were subsequently treated with brace, closed reduction (CR) or open reduction (OR) before 6 months of age.
Methods:
Fifty infants (66 hip dislocations) who failed Pavlik harness therapy between 2000 and 2018 and were treated with a rigid abduction brace or undergoing a CR or OR/cast were evaluated. All demographic data obtained from the medical system, developments and complications during the follow-up and treatment process were recorded and evaluated.
Results:
Fifty infants (66 hips) with dislocated hips failed Pavlik harness therapy. Of these, 9 infants (12 hips) underwent rigid abduction splint therapy: 9 hips were successful, 2 hips had CR and 1 had OR. Thirty-eight infants (51 hips) had index CR, of which 3 (3 hips) failed and had OR. Radiographs of 49 hips (44 patients) were normal at the final evaluation. Pavlik harness therapy starting after 3 weeks (P = 0.028) and unilateral dislocations (P = 0.028) increased the risk of needing operating room. There was an association between OR and avascular necrosis (P = 0.025), but not between OR and other complications-dysplasia and re-dislocation/subluxation (P = 0.257 and P = 0.508, respectively).
Conclusion:
Closed treatment of hip dislocation is possible in most babies who fail Pavlik treatment. Babies who are started on Pavlik therapy after 3 weeks of age may be at increased risk of needing an operating room.
Level Of Evidence:
IV.
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