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

Abstract

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). 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. 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). 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 6months of age. Meanwhile, a close monitoring by dynamic ultrasonography is required due to the risk of AVN.