Surgical technique: Pavlik harness and closed reduction for developmental dysplasia of the hip

Abstract

Developmental dysplasia of the hip (DDH) is a common pediatric disorder with 1 % of children experiencing subluxation or dysplasia and 0.1 % of children having a dislocated hip. Diagnosis of the disorder is initially found on physical exam, but further confirmation is done with radiographic and ultrasonographic imaging of the hip. Treatment of DDH is essential to prevent significant future disability. Regardless of the treatment modality, the goal of treatment has been to maintain a stable concentrically reduced hip joint to promote acetabular remodeling and long-term stability. Several treatments exist with nonsurgical options including the Pavlik harness and closed reduction of the hip with spica casting. Surgical choices are open reduction of the hip with the option of a femoral or acetabular osteotomy. The choice of treatment is based on several factors with the primary factors including age of the patient and degree of hip stability. Among the nonsurgical options, the Pavlik harness has become the standard treatment for infants with dysplasia and reducible hips. The outcomes have demonstrated success between 53 % and 99 % with infrequent complicationsof osteonecrosis, femoral nerve palsy, and Pavlik harness disease. When children are considered too old for the harness or have failed the Pavlik harness, the alternative treatment is closed reduction of the hip and spica casting. However, closed reduction of the hip and spica casting are associated with a high rate of conversion to open reduction and a 22-66 % need for future treatment or surgery.