Skip to main content

Advertisement

SpringerLink
Log in

Impact of Failed Pavlik Harness Treatment on the Outcomes Following Closed or Open Reduction in Developmental Dysplasia of the Hip

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

To investigate the impact of failed Pavlik harness (PH) treatment on the outcomes following closed reduction (CR) or open reduction (OR) in developmental dysplasia of the hip (DDH).

Methods

Ninety-three DDH patients treated with CR or OR were enrolled. One group of which received previous PH treatment (F group) and the other (L group) not. The clinical outcomes were evaluated according to McKay’s criteria. Radiographs were evaluated for acetabular index (AI) and the degree of dislocation of the hips.

Results

A higher rate of CR was found in F group (P = 0.034). Before CR/OR, the mean AI in F group was significantly lower than that in L group (P = 0.000), while at the last follow-up, the AIs in both groups were all improved. In F group, there were 7 (16.67%), 18 (42.86%) and 17 (40.48%) hips were classified as Graf type II, III and IV pathologic changes, respectively, when PH treatment started, while the corresponding data were 17 (40.48%), 17 (40.48%) and 8 (19.05%) after PH treatment (P = 0.024). At the last follow-up, no significant difference was found concerning the complications between the two groups (P > 0.05).

Conclusions

PH treatment, even if failed, may have the ability of accelerating the development of the acetabulum and increasing the rate of successful CR. Thus we advocate a trial of PH treatment for all DDH patients less than 6 months of age. Meanwhile, a close monitoring by dynamic ultrasonography is required due to the risk of AVN.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Li, Y., Xu, H., Li, J., Yu, L., Liu, Y., Southern, E., et al. (2015). Early predictors of acetabular growth after closed reduction in late detected developmental dysplasia of the hip. Journal of Pediatric Orthopedics. Part B, 24(1), 35–39. https://doi.org/10.1097/BPB.0000000000000111

    Article  PubMed  Google Scholar 

  2. Pavlik, A. (1992). The functional method of treatment using a harness with stirrups as the primary method of conservative therapy for infants with congenital dislocation of the hip. 1957. Clinical Orthopaedics and Related Research, 281, 4–10.

    Article  Google Scholar 

  3. Kelley, S. P., Feeney, M. M., Maddock, C. L., Murnaghan, M. L., & Bradley, C. S. (2019). Expert-based consensus on the principles of Pavlik Harness management of developmental dysplasia of the hip. JB JS Open Access., 4(4), e0054. https://doi.org/10.2106/JBJS.OA.18.00054

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Kitoh, H., Kawasumi, M., & Ishiguro, N. (2009). Predictive factors for unsuccessful treatment of developmental dysplasia of the hip by the Pavlik harness. Journal of Pediatric Orthopedics, 29(6), 552–557. https://doi.org/10.1097/BPO.0b013e3181b2f200

    Article  PubMed  Google Scholar 

  5. Place, M. J., Parkin, D. M., & Fritton, J. M. (1978). Effectiveness of neonatal screening for congenital dislocation of the hip. Lancet, 2(8083), 249–250. https://doi.org/10.1016/s0140-6736(78)91758-0

    Article  CAS  PubMed  Google Scholar 

  6. Vallamshetla, V. R., Mughal, E., & O’Hara, J. N. (2006). Congenital dislocation of the hip. A re-appraisal of the upper age limit for treatment. Journal of Bone and Joint Surgery. British Volume, 88(8), 1076–1081. https://doi.org/10.1302/0301-620X.88B8.17592

    Article  CAS  PubMed  Google Scholar 

  7. Arneill, M., Cosgrove, A., & Robinson, E. (2021). Should closed reduction of the dislocated hip be attempted after failed Pavlik harness treatment in developmental dysplasia of the hip? Bone and Joint Open, 2(8), 584–588. https://doi.org/10.1302/2633-1462.28.BJO-2021-0088.R1

    Article  PubMed  Google Scholar 

  8. McKay, D. W. (1974). A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clinical Orthopaedics and Related Research, 98, 124–132. https://doi.org/10.1097/00003086-197401000-00013

    Article  Google Scholar 

  9. Tonnis, D. (1990). Surgical treatment of congenital dislocation of the hip. Clinical Orthopaedics and Related Research, 258, 33–40.

    Article  Google Scholar 

  10. Graf, R. (1984). Classification of hip joint dysplasia by means of sonography. Archives of Orthopaedic and Trauma Surgery, 102(4), 248–255. https://doi.org/10.1007/BF00436138

    Article  CAS  Google Scholar 

  11. Kalamchi, A., & MacEwen, G. D. (1980). Avascular necrosis following treatment of congenital dislocation of the hip. Journal of Bone and Joint Surgery. American Volume, 62(6), 876–888.

    Article  CAS  Google Scholar 

  12. Choudry, Q., & Paton, R. W. (2017). Pavlik harness treatment for pathological developmental dysplasia of the hip: meeting the standard? Journal of Pediatric Orthopedics. Part B, 26(4), 293–297. https://doi.org/10.1097/BPB.0000000000000413

    Article  PubMed  Google Scholar 

  13. Cook, K. A., Schmitt, M., Ingram, M., Larson, J. E., Burgess, J., & Janicki, J. A. (2019). Pavlik harness initiation on barlow positive hips: can we wait? Journal of Orthopaedics, 16(5), 378–381. https://doi.org/10.1016/j.jor.2019.03.012

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sankar, W. N., Gornitzky, A. L., Clarke, N. M. P., Herrera-Soto, J. A., Kelley, S. P., Matheney, T., et al. (2019). Closed reduction for developmental dysplasia of the hip: early-term results from a prospective. Multicenter Cohort. J Pediatr Orthop., 39(3), 111–118. https://doi.org/10.1097/BPO.0000000000000895

    Article  PubMed  Google Scholar 

  15. Cha, S. M., Shin, H. D., & Shin, B. K. (2018). Long-term results of closed reduction for developmental dislocation of the hip in children of walking age under eighteen months old. International Orthopaedics, 42(1), 175–182. https://doi.org/10.1007/s00264-017-3685-x

    Article  PubMed  Google Scholar 

  16. Ömeroğlu, H. (2018). Treatment of developmental dysplasia of the hip with the Pavlik harness in children under six months of age: Indications, results and failures. Journal of Children’s Orthopaedics, 12(4), 308–316. https://doi.org/10.1302/1863-2548.12.180055

    Article  PubMed  PubMed Central  Google Scholar 

  17. Vaquero-Picado, A., González-Morán, G., Garay, E. G., & Moraleda, L. (2019). Developmental dysplasia of the hip: update of management. EFORT Open Rev., 4(9), 548–556. https://doi.org/10.1302/2058-5241.4.180019

    Article  PubMed  PubMed Central  Google Scholar 

  18. Alassaf, N. (2020). Treatment of developmental dysplasia of the hip (DDH) between the age of 18 and 24 months. European Journal of Orthopaedic Surgery & Traumatology, 30(4), 637–641. https://doi.org/10.1007/s00590-019-02601-5

    Article  Google Scholar 

  19. Li, Y., Guo, Y., Li, M., Zhou, Q., Liu, Y., Chen, W., et al. (2018). Acetabular index is the best predictor of late residual acetabular dysplasia after closed reduction in developmental dysplasia of the hip. International Orthopaedics, 42(3), 631–640. https://doi.org/10.1007/s00264-017-3726-5

    Article  PubMed  Google Scholar 

  20. Zhang, Z., Li, H., Li, H., & Zhang, Z. (2020). Timing for closed reduction procedure for developmental dysplasia of the hip and its failure analysis. BMC Musculoskeletal Disorders, 21(1), 613. https://doi.org/10.1186/s12891-020-03635-1

    Article  PubMed  PubMed Central  Google Scholar 

  21. Chen, I. H., Kuo, K. N., & Lubicky, J. P. (1994). Prognosticating factors in acetabular development following reduction of developmental dysplasia of the hip. Journal of Pediatric Orthopedics, 14(1), 3–8. https://doi.org/10.1097/01241398-199401000-00002

    Article  CAS  PubMed  Google Scholar 

  22. Terjesen, T., Horn, J., & Gunderson, R. B. (2014). Fifty-year follow-up of late-detected hip dislocation: clinical and radiographic outcomes for seventy-one patients treated with traction to obtain gradual closed reduction. Journal of Bone and Joint Surgery. American Volume, 96(4), e28. https://doi.org/10.2106/JBJS.M.00397

    Article  PubMed  Google Scholar 

  23. Luhmann, S. J., Bassett, G. S., Gordon, J. E., Schootman, M., & Schoenecker, P. L. (2003). Reduction of a dislocation of the hip due to developmental dysplasia. Implications for the need for future surgery. The Journal of Bone and Joint Surgery. American Volume, 85(2), 239–243. https://doi.org/10.2106/00004623-200302000-00009

    Article  PubMed  Google Scholar 

  24. Jones, G. T., Schoenecker, P. L., & Dias, L. S. (1992). Developmental hip dysplasia potentiated by inappropriate use of the Pavlik harness. Journal of Pediatric Orthopedics, 12(6), 722–726. https://doi.org/10.1097/01241398-199211000-00004

    Article  CAS  PubMed  Google Scholar 

  25. Alexiev, V. A., Harcke, H. T., & Kumar, S. J. (2006). Residual dysplasia after successful Pavlik harness treatment: early ultrasound predictors. Journal of Pediatric Orthopedics, 26(1), 16–23. https://doi.org/10.1097/01.bpo.0000187995.02140.c7

    Article  PubMed  Google Scholar 

  26. Suzuki, S. (1993). Ultrasound and the Pavlik harness in CDH. Journal of Bone and Joint Surgery. British Volume, 75(3), 483–487. https://doi.org/10.1302/0301-620X.75B3.8496228

    Article  CAS  PubMed  Google Scholar 

  27. Senaran, H., Bowen, J. R., & Harcke, H. T. (2007). Avascular necrosis rate in early reduction after failed Pavlik harness treatment of developmental dysplasia of the hip. Journal of Pediatric Orthopedics, 27(2), 192–197. https://doi.org/10.1097/01.bpb.0000248567.49089.f0

    Article  PubMed  Google Scholar 

  28. Gardner, R. O., Bradley, C. S., Howard, A., Narayanan, U. G., Wedge, J. H., & Kelley, S. P. (2014). The incidence of avascular necrosis and the radiographic outcome following medial open reduction in children with developmental dysplasia of the hip: a systematic review. The Bone and Joint Journal, 96-B(2), 279–286. https://doi.org/10.1302/0301-620X.96B2.32361

    Article  CAS  PubMed  Google Scholar 

  29. Novais, E. N., Hill, M. K., Carry, P. M., & Heyn, P. C. (2016). Is age or surgical approach associated with osteonecrosis in patients with developmental dysplasia of the hip? A Meta-analysis. Clinical Orthopaedics and Related Research, 474(5), 1166–1177. https://doi.org/10.1007/s11999-015-4590-5

    Article  PubMed  Google Scholar 

  30. Pospischill, R., Weninger, J., Ganger, R., Altenhuber, J., & Grill, F. (2012). Does open reduction of the developmental dislocated hip increase the risk of osteonecrosis? Clinical Orthopaedics and Related Research, 470(1), 250–260. https://doi.org/10.1007/s11999-011-1929-4

    Article  PubMed  Google Scholar 

  31. Huang, S. C., & Wang, J. H. (1997). A comparative study of nonoperative versus operative treatment of developmental dysplasia of the hip in patients of walking age. Journal of Pediatric Orthopedics, 17(2), 181–188. https://doi.org/10.1097/00004694-199703000-00009

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This work was supported by the Natural Science Foundation of Anhui Province (Grant number 1808085MH288).

Author information

Authors and Affiliations

  1. Department of Pediatric Orthopedic, The Affiliated Provincial Pediatric Hospital of Anhui Medical University, No 39, Wangjiang Road, Hefei City, China

    Yong Liu, Jun Sun & Yapeng Zhang

  2. No 91126 Military Hospital of Chinese PLA, No 116, Youyi Road, Lvshunkou District, Dalian City, China

    Lisheng Kan

Authors
  1. Yong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lisheng Kan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jun Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yapeng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by YL, LK, JS and YZ. The first draft of the manuscript was written by LK and YL commented on previous versions of the manuscript. All authors read and approved the final manuscript. The authors YL and LK contributed equally to this work and should be considered as co-first authors.

Corresponding authors

Correspondence to Lisheng Kan or Jun Sun.

Ethics declarations

Conflict of Interest

The authors have no conflicts of interest to disclose.

Ethical Approval

This is an observational study. The Research Ethics Committee of the Affiliated Provincial Pediatric Hospital of Anhui Medical University has confirmed that no ethical approval is required.

Consent to Participate

Written informed consent was obtained from the parents.

Consent to Publish

The authors affirm that the parents provided informed consent for publication of the present study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, Y., Kan, L., Sun, J. et al. Impact of Failed Pavlik Harness Treatment on the Outcomes Following Closed or Open Reduction in Developmental Dysplasia of the Hip. JOIO 56, 1634–1639 (2022). https://doi.org/10.1007/s43465-022-00680-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-022-00680-x

Keywords

Search

Navigation