Top

Published in:

Open Access 01-09-2013 | Original Article

The Pavlik harness in the treatment of developmentally dislocated hips: results of Japanese multicenter studies in 1994 and 2008

Authors: Ikuo Wada, Eisuke Sakuma, Takanobu Otsuka, Kenjiro Wakabayashi, Kinya Ito, Osamu Horiuchi, Yoshimi Asagai, Makoto Kamegaya, Eiji Goto, Shinichi Satsuma, Daisuke Kobayashi, Susumu Saito, Mayuki Taketa, Kazuharu Takikawa, Yasuharu Nakashima, Tadashi Hattori, Shigeru Mitani, Akifusa Wada

Published in: Journal of Orthopaedic Science | Issue 5/2013

Abstract

Background

It has already been more than 50 years since the Pavlik harness was introduced in Japan, and today the Pavlik harness is widely recognized as the standard initial treatment modality for developmental dysplasia of the hip. We performed a multicenter nationwide questionnaire study concerning the results of Pavlik harness treatment twice in 1994 and 2008.

Methods

In 1994 and in 2008, we sent questionnaires to 12 institutes in Japan specializing mainly in pediatric orthopedics. We compare the results of these two studies and discuss differences in reduction rates, incidence of avascular necrosis in the femoral epiphysis and the percentage of joints with acceptable morphology (Severin grade I + II/total) at skeletal maturity. We statistically assessed these results to see whether there were changes in the treatment outcomes over this 14-year period.

Results

Reduction of the dislocated hips was obtained by the Pavlik harness in 80.2 % (1990/2481 hips; 1994) and 81.9 % (1248/1523 hips; 2008). The incidences of avascular necrosis of the proximal femoral epiphysis in the dysplastic hips were 14.3 % (119/835 hips; 1994) and 11.5 % (76/663 hips; 2008). The type of avascular necrosis in hips from the 2008 study was determined according to the classification of Kalamchi and MacEwen: 24/69 hips (34.8 %) were classified as group I; 20/69 hips (29.0 %) as group II; 11/69 hips (15.9 %) as group Ill; 14/69 hips (20.3 %) as group IV. The percentages of hips with acceptable outcomes at skeletal maturity discerned from Severin X-ray changes (grade I + II/total) were 72.3 % (604/835 hips; 1994) and 77.7 % (488/628 hips; 2008).

Conclusion

Reduction rates and the incidence of avascular necrosis in 2008 were statistically similar to the results in 1994. The rate of acceptable outcome (Severin grade I + II/total) in 2008 was statistically higher than that of 1994.

Mubarak SJ, Bialik V. Pavlik: the man and his method. J Pediatr Orthop. 2003;23:342–6.PubMed

Suzuki R. Complications of the treatment of congenital dislocation of the hip by the Pavlik harness. Int Orthop. 1979;3:77–9.PubMedCrossRef

Pavlik A. Die functionelle Behandlungs methode mittels Riemenbugel als Prinzip der Konservativen Therapie bei angeboresenen Huftgelenks verrenkungen der Sanglinge. Z Orthop. 1957;89:341–52.PubMed

Peltier LF. The functional method of treatment using a harness with stirrups as the primary method of conservative therapy for infants with congenital dislocation of the hip. Clin Orthop Rel Res. 1992;281:4–10.

Grill F, Bensahel H, Canadell J, Dungl P, Matasovic T, Vízkelety T. The Pavlik harness in the treatment of congenital dislocating hip: report on a multicenter study of the European Paediatric Orthopaedic Society. J Pediatr Orthop. 1988;8:1–8.PubMedCrossRef

Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1980;62:876–88.PubMed

Kasser JR, Bowen JR, MacEwen GD. Varus derotation osteotomy in the treatment of persistent dysplasia in congenital dislocation of the hip. J Bone Joint Surg Am. 1985;67:195–202.PubMed

Pavlik A. Trmeny jako pomucka pri leceni vrozenych dysplasia kycli u deti. Lek Listy. 1950;5:81–5.

Bialik V, Reis ND. Stirrups as an aid in the treatment of congenital dysplasias of the hip in children. J Pediatr Orthop. 1989;9:157–9.CrossRef

10.

Pavlik A. Kotazce Puvodnosti leceni vrozenych kycelnich dysplasia aktivinim phybem ve tmenech. Acta Chir Orthop Traum Czech. 1959;26:5–6.

11.

Bialik V. To the question of originality of treatment of congenital hip dysplasias by active movement in the stirrups. J Pediatr Orthop B. 2001;10:165–8.

12.

Viere RG, Birch JG, Herring JA, Roach JW, Johnston CE. Use of the Pavlik harness in congenital dislocation of the hip. An analysis of failures of treatment. J Bone Joint Surg Am. 1990;72:238–44.PubMed

13.

Harding MG, Harcke HT, Bowen JR, Guille JT, Glutting J. Management of dislocated hips with Pavlik harness treatment and ultrasound monitoring. J Pediatr Orthop. 1997;17:189–98.PubMed

14.

Atalar H, Sayli U, Yavuz OY, Uraş I, Dogruel H. Indicators of successful use of the Pavlik harness in infants with developmental dysplasia of the hip. Int Orthop. 2007;31:145–50.PubMedCrossRef

15.

Kruczynski J. Avascular necrosis of the proximal femur in developmental dislocation of the hip. Acta Orthop Scand. 1996;67(Suppl 268):7–12.

16.

Pap K, Kiss S, Shisha T, Marton-Szücs G, Szöke G. The incidence of avascular necrosis of the healthy, contralateral femoral head at the end of the use of Pavlik harness in unilateral hip dysplasia. Int Orthop. 2006;30:348–51.PubMedCrossRef

17.

Lerman JA, Emans JB, Millis MB, Share J, Zurakowski D, Kasser JR. Early failure of Pavlik harness treatment for developmental hip dysplasia: clinical and ultrasound predictors. J Pediatr Orthop. 2001;21:348–53.PubMed

18.

Suzuki S, Yamamuro T. Avascular necrosis in patients treated with the Pavlik harness for congenital dislocation of the hip. J Bone Joint Surg Am. 1990;72(7):1048–55.PubMed

19.

Kitoh H, Kawasumi M, Ishiguro N. Predictive factors for unsuccessful treatment of developmental dysplasia of the hip by the Pavlik harness. J Pediatr Orthop. 2009;29:552–7.PubMedCrossRef

20.

Iwasaki K. Treatment of congenital dislocation of the hip by the Pavlik harness. Mechanism of reduction and usage. J Bone Joint Surg Am. 1983;65:760–7.PubMed

21.

Harcke HT, Kumar SJ. The role of ultrasound in the diagnosis and management of congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1991;73:622–8.PubMed

22.

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;58:1000–4.PubMed

Title: The Pavlik harness in the treatment of developmentally dislocated hips: results of Japanese multicenter studies in 1994 and 2008
Authors: Ikuo Wada
Eisuke Sakuma
Takanobu Otsuka
Kenjiro Wakabayashi
Kinya Ito
Osamu Horiuchi
Yoshimi Asagai
Makoto Kamegaya
Eiji Goto
Shinichi Satsuma
Daisuke Kobayashi
Susumu Saito
Mayuki Taketa
Kazuharu Takikawa
Yasuharu Nakashima
Tadashi Hattori
Shigeru Mitani
Akifusa Wada
Publication date: 01-09-2013
Publisher: Springer Japan
Published in: Journal of Orthopaedic Science / Issue 5/2013
Print ISSN: 0949-2658
Electronic ISSN: 1436-2023
DOI: https://doi.org/10.1007/s00776-013-0432-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Pavlik harness in the treatment of developmentally dislocated hips: results of Japanese multicenter studies in 1994 and 2008

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2013

Posterior buttress plate with locking compression plate for Hoffa fracture

The D-repeat polymorphism in the ASPN gene and primary knee osteoarthritis in a Mexican mestizo population: a case–control study

Nondura-based clear cell meningioma of the cauda equina in an adult

Factors influencing the residual rib hump after posterior spinal fusion for adolescent idiopathic scoliosis with Lenke 1 and 2 curves

Changes of body balance before and after total knee arthroplasty in patients who suffered from bilateral knee osteoarthritis

More radial shortening after low-energy Colles’ fractures is associated with type 2 diabetes mellitus among postmenopausal women, irrespective of bone mineral density