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[Treatment of congenital hip dislocation using Pavlik's harness. Long term results]
1Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Paris.
Insights
The Pavlik harness is effective for congenital hip dislocation but carries risks. Severity of dislocation and passive hip abduction significantly influence outcomes and avascular necrosis, necessitating careful patient selection.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Hip Dysplasia Treatment
Background:
- Congenital hip dislocation is a common pediatric condition.
- The Pavlik harness is a widely used treatment method.
- Long-term outcomes and complication factors require evaluation.
Purpose of the Study:
- To assess long-term results of Pavlik harness treatment for congenital hip dislocation.
- To identify causes of treatment failure.
- To determine factors contributing to avascular necrosis.
Main Methods:
- 141 children (159 hips) with dislocation and 30 with acetabular dysplasia were treated.
- Follow-up averaged 74 months.
- Radiographic measurements and statistical analysis (chi-squared, P-test) evaluated treatment success and complications.
Main Results:
- 10.6% of dislocated hips were not reduced by the harness.
- Avascular necrosis occurred in 16.1% of reduced hips and 30% of unreduced hips.
- Long-term outcomes (Severin classification) showed 61 excellent and 33 good results in 99 hips followed >72 months.
Conclusions:
- Age, sex, and prior treatment did not correlate with failure or avascular necrosis.
- Hip passive abduction and dislocation severity were key factors in complications.
- Pavlik harness use requires strict indication criteria, particularly passive abduction >30 degrees and distance H >4 mm.
Purpose Of The Study:
After many years using Pavlik harness for treatment of congenital hips dislocation, it is important to evaluate long-term results, failure causes and factors responsible for avascular necrosis.
Material:
One hundred and forty one children were treated by this mean (159 dislocated hips, 30 acetabular dysplasia). The follow up was 74 months (12-175).
Methods:
In this study, the severity of the dislocation was evaluated by antero-posterior radiographs of the pelvis. The importance of proximal dislocation was measured by the distance from the top of the proximal femoral metaphysis to the Y line and the lateralization by the distance from the medial border of the proximal femoral metaphysis to the ischium. Results were appreciated using Severin classification modified by Kasser and Mose's circles. Several factors as age at the beginning of treatment, sex, previous treatment, passive abduction of the hip, amount of dislocation were statistically evaluated (chi 2 and P test).
Results:
Of 159 dislocated hips, 10 (6.3 per cent) were not reduced by the harness. Temporary growth modifications and avascular necrosis were observed in 24 (16.1 per cent) of 149 reduced hips. We shall add to these, 3 avascular necrosis in 10 hips which were not reduced in the pavlik harness and 2 avascular necrosis which occurred in normal hips. This complication was not encountered in dysplasic hips without dislocation. Using Severin classification, there was 61 excellent, 33 good and 5 fair results in the group of 99 hips followed for more than 72 months. Of all growth anomalies and avascular necrosis, only half of them keep sequelae at the last follow-up.
Discussion:
Some factors as age, sex, previous treatment have no incidence in the number of failures and avascular necrosis. On the contrary, passive abduction of the hip, severity of the dislocation were responsible for most of these complications. Pavlik harness must be used with circonspection. It can be used only where passive abduction is superior to 30 degrees and distance H superior to 4 mm. In other cases, it is preferable to use progressive traction.
Conclusion:
Pavlik harness is widely used for treatment of congenital hip dislocation. Reduction can be obtained as stabilisation and correction of acetabular dysplasia. The risk for avascular remains relatively high. The use of the harness needs a rigourous choice of indications.