DDH treatment with Pavlik harness: Weekly ultrasound monitoring for stability

Normal development of the infantile hip joint relies upon the congruent and stable relationship of the femoral head and the acetabulum. Treatment with dynamic bracing for instability of the hip joint is accepted, but the duration of treatment required and the timing of follow up is of current debate. The aim of this study was to determine the outcome of Pavlik Harness treatment in children with early presenting ultrasonographically unstable and dislocated hips, independently of morphological appearance of the joint. Children suspected of having or to be high risk for DDH were assessed by clinical and ultrasound examination. Ultrasonographically unstable and dislocated hips were treated in the Pavlik harness and reviewed weekly with ultrasound. Once reduction had been maintained for six consecutive weeks weaning from the harness over the following 5 weeks was started. Thirty three children (37 hips) were treated. The mean follow up time was 2.9 years (6 weeks - 5.3 years). Six hips failed to remain reduced. There was no statistically difference in age at commencement of Pavlik harness treatment between the successful and unsuccessfully treated groups (p>0.1). Evaluation of the duration of splintage required to achieve reduction of the hip compared against the age of the child at the commencement of splintage revealed no statistically significant correlation (p>0.1) to be present. Early treatment of hip instability within the first weeks of life, even with an apparent normal morphology of the acetabular socket, results in normal joint development, decreasing the need for prolonged compliance with treatment. It may also reduce the incidence of late presentation, without increasing the rate of complications (0 in our series).