A: The Pavlik harness
is often used as the
initial treatment of hip
dysplasia in infants,
also know as
developmental
dysplasia of the hip
(DDH).
Ramsey PL, Lasser S, MacEwen GD.
Congenital dislocation of the hip. Use
of the Pavlik harness in the child
during the first six months of life. J
Bone Joint Surg Am. 1976
Oct;58(7):1000-4.
is often used as the
initial treatment of hip
dysplasia in infants,
also know as
developmental
dysplasia of the hip
(DDH).
Ramsey PL, Lasser S, MacEwen GD.
Congenital dislocation of the hip. Use
of the Pavlik harness in the child
during the first six months of life. J
Bone Joint Surg Am. 1976
Oct;58(7):1000-4.
What is the Pavlik Harness?
It is a soft dynamic brace that maintains the hip in flexion (knee up towards the head) and
abduction (knee away from the centerline). This position maintains the proper position of
the femoral head and allows for "tightening up" of the ligamentous structures as well as
for stimulation of normal formation and deepening of the hip socket.
http://www.massgeneral.org/ortho/Hip_Dysplasia.htm
Congenital Hip Dislocations...
True dislocation of the hips occurs in about 1 in 1,000 births although as many as 1 in
100 may have clicky hips. When screening was initiated the incidence was found to be
about 3 times that previously suspected, suggesting that 2 in 3 recover spontaneously.
As we do not know which 2 in 3 these are and the implications for the third that does not
recover are serious, it is wise to treat all. Some early work, published in 1962, suggested
that 1 in 60 had unstable hips at birth, 60% of these became stable by 1 month and 88%
by 2 months, leaving just 1 baby in 500 with unstable hips after 2 months. Neonatal
screening for CDH has been national policy in the UK since 1969.
Risk Factors...
* There are racial differences. In the USA it is found that native Americans and
Laplanders have a high incidence whilst Chinese and African Americans have a low
incidence
* Positive family history of the condition increases the risk in a manner suggestive of
multifactorial inheritance.
* About 80 to 85% are female
* About 60% of cases are first-born, compared with about 40% of all babies
* Breech presentation increases the risk of CDH. The extended breech position in which
knees are extended is a higher risk than with knees flexed. Elective caesarian section
reduces the risk compared with vaginal breech delivery but it remains higher than after a
cephalic presentation.
* Restriction of movement as with oligohydramnios increases the risk
* It is commoner with neuromuscular disorders, such as cerebral palsy, meningomyelocele
and arthrogryposis.
* The left hip is dislocated more often than the right. This is thought to be due to the
common position of the baby's left hip against the mother's sacrum, restricting movement
* In cultures that use swaddling of babies, forcing the hips into extension and adduction, it
is more common.
http://www.patient.co.uk/showdoc/40024965/
The Pavlik Harness...
The Pavlik harness should be placed such that the chest strap is at the nipple line with 2
fingerbreadths of space between the chest and strap. The anterior strap is at the
midaxillary line and should be set such that the hips are flexed to 100-110°. Excessive hip
flexion can lead to femoral nerve compression and inferior dislocations. Quadriceps
function should be determined at all clinic visits. The posterior abduction strap should be
at the level of the child's scapula and adjusted to allow for comfortable abduction. This
should prevent the hips from adducting to the extent that the hips dislocate. Excessive
abduction should be avoided because of concern regarding the development of
avascular necrosis. Fitting should then be checked clinically within the first week and then
weekly thereafter. Carefully monitoring the patient to ensure the harness fits and the hips
are reduced is important.
Ultrasonography...
Ultrasonography is an excellent means of documenting the reduction of the hip in the
Pavlik harness and should be performed early in the course of treatment (Suzuki, 1993).
If the hip is posteriorly subluxed, then the Pavlik harness therapy should be discontinued.
Using the Pavlik harness for guided reduction, which occurs when the hip does not
completely reduce initially but is pointed towards the triradiate cartilage, is controversial.
http://www.emedicine.com/orthoped/topic456.htm
The US Preventative Service Task Force (USPSTF)...
The U.S. Preventive Services Task Force (USPSTF) recently concluded that evidence is
insufficient to recommend routine screening for DDH in infants as a means to prevent
adverse outcomes. Evidence shows that screening leads to earlier identification of DDH;
however, the USPSTF concluded that 60 to 80 percent of the newborn hips identified by
physical examination and more than 90 percent identified by ultrasonography as
abnormal or as suspicious for DDH resolve spontaneously and require no intervention.
The long-term results of Pavlik harness treatment (e.g., nonoperative treatment) show a
95 percent success rate for acetabular dysplasia and subluxation.22,23 The success rate
drops to 80 percent for frank dislocation.
http://www.aafp.org/afp/20061015/1310.html
It is a soft dynamic brace that maintains the hip in flexion (knee up towards the head) and
abduction (knee away from the centerline). This position maintains the proper position of
the femoral head and allows for "tightening up" of the ligamentous structures as well as
for stimulation of normal formation and deepening of the hip socket.
http://www.massgeneral.org/ortho/Hip_Dysplasia.htm
Congenital Hip Dislocations...
True dislocation of the hips occurs in about 1 in 1,000 births although as many as 1 in
100 may have clicky hips. When screening was initiated the incidence was found to be
about 3 times that previously suspected, suggesting that 2 in 3 recover spontaneously.
As we do not know which 2 in 3 these are and the implications for the third that does not
recover are serious, it is wise to treat all. Some early work, published in 1962, suggested
that 1 in 60 had unstable hips at birth, 60% of these became stable by 1 month and 88%
by 2 months, leaving just 1 baby in 500 with unstable hips after 2 months. Neonatal
screening for CDH has been national policy in the UK since 1969.
Risk Factors...
* There are racial differences. In the USA it is found that native Americans and
Laplanders have a high incidence whilst Chinese and African Americans have a low
incidence
* Positive family history of the condition increases the risk in a manner suggestive of
multifactorial inheritance.
* About 80 to 85% are female
* About 60% of cases are first-born, compared with about 40% of all babies
* Breech presentation increases the risk of CDH. The extended breech position in which
knees are extended is a higher risk than with knees flexed. Elective caesarian section
reduces the risk compared with vaginal breech delivery but it remains higher than after a
cephalic presentation.
* Restriction of movement as with oligohydramnios increases the risk
* It is commoner with neuromuscular disorders, such as cerebral palsy, meningomyelocele
and arthrogryposis.
* The left hip is dislocated more often than the right. This is thought to be due to the
common position of the baby's left hip against the mother's sacrum, restricting movement
* In cultures that use swaddling of babies, forcing the hips into extension and adduction, it
is more common.
http://www.patient.co.uk/showdoc/40024965/
The Pavlik Harness...
The Pavlik harness should be placed such that the chest strap is at the nipple line with 2
fingerbreadths of space between the chest and strap. The anterior strap is at the
midaxillary line and should be set such that the hips are flexed to 100-110°. Excessive hip
flexion can lead to femoral nerve compression and inferior dislocations. Quadriceps
function should be determined at all clinic visits. The posterior abduction strap should be
at the level of the child's scapula and adjusted to allow for comfortable abduction. This
should prevent the hips from adducting to the extent that the hips dislocate. Excessive
abduction should be avoided because of concern regarding the development of
avascular necrosis. Fitting should then be checked clinically within the first week and then
weekly thereafter. Carefully monitoring the patient to ensure the harness fits and the hips
are reduced is important.
Ultrasonography...
Ultrasonography is an excellent means of documenting the reduction of the hip in the
Pavlik harness and should be performed early in the course of treatment (Suzuki, 1993).
If the hip is posteriorly subluxed, then the Pavlik harness therapy should be discontinued.
Using the Pavlik harness for guided reduction, which occurs when the hip does not
completely reduce initially but is pointed towards the triradiate cartilage, is controversial.
http://www.emedicine.com/orthoped/topic456.htm
The US Preventative Service Task Force (USPSTF)...
The U.S. Preventive Services Task Force (USPSTF) recently concluded that evidence is
insufficient to recommend routine screening for DDH in infants as a means to prevent
adverse outcomes. Evidence shows that screening leads to earlier identification of DDH;
however, the USPSTF concluded that 60 to 80 percent of the newborn hips identified by
physical examination and more than 90 percent identified by ultrasonography as
abnormal or as suspicious for DDH resolve spontaneously and require no intervention.
The long-term results of Pavlik harness treatment (e.g., nonoperative treatment) show a
95 percent success rate for acetabular dysplasia and subluxation.22,23 The success rate
drops to 80 percent for frank dislocation.
http://www.aafp.org/afp/20061015/1310.html
What is the Pavlik Harness?
This publications contains the opinions and ideas of its author(s). It is intended to provide
helpful and informative material on the subjects addressed. It is written with the
understanding that the author(s) is (are) not engaged in rendering medical, health, or any
other kind of professional service(s). The reader should consult his or her medical, health or
other competent professional before adopting any of the suggestions. The author(s)
specifically disclaim all responsibility for any liability, loss, or risk, personal or otherwise,
which is incurred as a consequence, directly or indirectly, of the use and application of any of
the contents of this site.
helpful and informative material on the subjects addressed. It is written with the
understanding that the author(s) is (are) not engaged in rendering medical, health, or any
other kind of professional service(s). The reader should consult his or her medical, health or
other competent professional before adopting any of the suggestions. The author(s)
specifically disclaim all responsibility for any liability, loss, or risk, personal or otherwise,
which is incurred as a consequence, directly or indirectly, of the use and application of any of
the contents of this site.
