The Journal of Bone and Joint Surgery, Vol 72, Issue 2 238-244, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Use of the Pavlik harness in congenital dislocation of the hip. An analysis of failures of treatment
RG Viere, JG Birch, JA Herring, JW Roach and CE Johnston
Department of Pediatric Orthopedics and Scoliosis Surgery, Texas Scottish Rite Hospital for Crippled Children, Dallas 75219.
In twenty-five patients, the Pavlik harness failed to obtain or maintain
reduction in thirty of thirty-five congenital dislocations of the hip. All
of the patients had met the clinical criteria for use of the harness in our
institution: they were less than seven months old, the femoral head pointed
to the triradiate cartilage on anteroposterior radiographs that were made
with the child wearing the harness, and they had no evidence of
neuromuscular disease or teratological dislocation. These patients were
compared with seventy-one patients (eighty-one dislocations) who had also
been treated with the Pavlik harness and in whom a stable reduction was
obtained and maintained. Statistically significant risk factors for failure
of the harness included an absent Ortolani sign at the initial evaluation,
bilateral dislocation, and an age of more than seven weeks before treatment
with the harness was begun. All thirty hips in which the harness failed to
obtain or maintain reduction had a subsequent attempt at closed reduction
after preliminary Bryant traction. Fifteen of these hips were successfully
reduced closed, but two later redislocated and needed an open reduction.
The remaining fifteen hips needed an open reduction, and two redislocated
and needed a second open reduction.
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