The Journal of Bone and Joint Surgery, Vol 63, Issue 8 1239-1248, Copyright © 1981 by Journal of Bone and Joint Surgery, Inc
Pitfalls in the use of the Pavlik harness for treatment of congenital dysplasia, subluxation, and dislocation of the hip
S Mubarak, S Garfin, R Vance, B McKinnon and D Sutherland
We reviewed the records of treatment of eighteen infants with congenital
dysplasia, subluxation, or dislocation of the hip who had problems with the
involved hip following treatment with the Pavlik harness. The most common
problem (seen in twelve patients with a dislocated hip) was failure to
obtain reduction. This failure was attributed primarily to improper use of
the harness by the physician. In some patients, three to five months
elapsed before the physician recognized the lack of reduction. In nine
patients, a Pavlik harness of poor quality and construction added to both
the physician's and the patient's problems, and in six patients, poor
patient compliance with the use of the harness was partially responsible
for the failure. In three patients who were initially treated in the Pavlik
harness, avascular necrosis of the hip subsequently developed, in two
following open reduction and in one after closed reduction and cast
application. The physician's indications for use and application of the
harness must be appropriate. The child must be examined frequently out of
the harness both clinically and roentgenographically. Failure to achieve
reduction or adductor relaxation must be recognized promptly and dealt with
immediately.
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