The creation of a Pavlik “hemi-harness” for a singly irreducible hip in bilateral dysplastic hips

Amit Atrey,Marcos Katchburian

doi:10.1007/s11832-009-0226-1

Amit Atrey, Marcos Katchburian

Open Access

https://doi.org/10.1007/s11832-009-0226-1

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Abstract

The treatment of bilaterally dislocated hips with a Pavlik harness can have deleterious effects if one hip remains dislocated. We assess the success of potentially leaving the persistently dislocated hip free and the relocated hip in a "hemi-Pavlik" harness. In this report, we retrospectively review three cases of bilaterally dislocated hips in children who were treated with a Pavlik harness. Only one hip was effectively reduced by the harness and, in each case, half of the harness was cut away to create a "hemi-Pavlik" harness and the free side was operated on at a later date. Initial follow-up has shown that the "hemi-Pavlik" harness is effective in maintaining reduction of one hip whilst leaving the other hip untreated, thus, avoiding the complications of prolonged use of the harness in an unreduced hip or having both hips dealt with operatively. We suggest, in the early stages, that if only one side of the bilaterally displaced hips can be reduced, the non-reduced side should be left free and an elective procedure carried out at a later stage. In the early stages, a "hemi-Pavlik" harness is effective in treating the reducible hip and causes no treatment obstacles for the irreducible side.

Highlights

Developmental dysplasia of the hip (DDH) denotes a wide spectrum of pathological conditions, ranging from subtle acetabular dysplasia to irreducible hip dislocation [1]
In this report, we retrospectively review three cases of bilaterally dislocated hips in children who were treated with a Pavlik harness
A ‘‘hemi-Pavlik’’ harness is effective in treating the reducible hip and causes no treatment obstacles for the irreducible side

Summary

Introduction

Developmental dysplasia of the hip (DDH) denotes a wide spectrum of pathological conditions, ranging from subtle acetabular dysplasia to irreducible hip dislocation [1]. When DDH is recognised in the first 6 months of life, treatment with a Pavlik harness frequently has good results, the success rate may be lower in children over 12 weeks of age [2,3,4,5]. Inappropriate continued use of a Pavlik harness when the hip remains unreduced can be detrimental [2]. The accuracy in the assessment of reduction has been improved with the use of ultrasound [6, 8,9,10]. If the hip fails to reduce after a reasonable time period (usually a maximum of 3 weeks), it is generally accepted that the Pavlik harness should be removed and an alternative treatment method sought [6]

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