Pavlik harness in early treatment of developmental dislocation of the hips: preliminary results and reasons for failure of reduction

Abstract

Objective To evaluate the result of early treatment for developmental dislocation of the hips by Pavlik harness,and to seek the reasons of failure.Methods We retrospectively reviewed the patients of developmental dislocation of the hips who initially received Pavlik harness treatment between 2009 January and 2013 march by ultrasound examination.163 cases (195 hips) were collected complete data and followed up for more than 1 year.We combined the Ortolani test and ultrasound examination to determine whether the dislocated hip was reducible or irreducible.The ultrasound examinations were conducted every week after Pavlik harness treatment.If the reduction was not achieved in three weeks after Pavlik harness treatment confirmed by ultrasound examination,we determined the treatment was failure.A plain anteroposterior radiograph was taken for measuring the acetabular index at the last follow up and T(o)nnis Criterion was accorded to evaluate the residual dysplasia.The Salter Criterion was used to evaluate the avascular necrosis of femoral head.The relationships between age,gender,single-sided,reducibility,the ultrasonic type and reduction were analyzed.Results In 195 dislocated hips,144 hips (73.8％) were treated successfully by Pavlik harness,51 hips were failed with 49 hips were changed to the cast and 4 hips refused.The average time of follow-up was 19 months (12-49 months).At the last follow-up,10 hips (6.9％,10/144) were residual dysplasia,4 hips (2.8％,4/144) occurred avascular necrosis of the femoral head.Univariate analysis showed that there was no significant correlation between age,gender,singlesided and reduction (P ＞ 0.05),but the ultrasonic type (Graf Type Ⅲ/Ⅳ,79.4％ vs.43.3％) and the reducibility (reducible/irreducible,79.1％/34.8％) were relevant factors (P ＜ 0.001).Multivariate analysis showed that the reducibility (OR=6.071,P=0.000)and ultrasonic type (OR=4.629,P ＜ 0.001) were independent factors.Further analysis revealed that only 12.5％ (1/8) of Graf Type Ⅳ with irreducible hips received reduction by harness.Conclusion Pavlik harness is an effective and safe method in early treatment of dislocated hips.Pavlik harness treatment applies for Graf Type Ⅲ reducible dislocated hips,and can be used as initial treatment for Graf Type Ⅲ with irreducible or Graf TypeⅣ and reducible dislocated hips which may have a higher failure rate.Pavlik harness should not be considered as the best choice for Graf Type Ⅳ irreducible dislocated hips. Key words: Hip dislocation; Bone diseases, developmental; Ultrasonography