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

Abstract

BackgroundIt 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.MethodsIn 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.ResultsReduction 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).ConclusionReduction 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.

Treatment of developmental dysplasia of the hip with the Pavlik harness in children under six months of age: Indications, results and failures

“…Infants between three and six months of age and CSHD grade IV hips had higher rates of failure and ON. 20 In a multicentre study from Japan 22 including nearly 4000 hips with complete dislocations (mean treatment initiation ages range from 3.5 to 4.8 months) that were followed until skeletal maturity, the rate of hip relocation by Pavlik’s method was around 80%, the rate of ON was about 11% and a satisfactory radiographic outcome without any additional osteotomies in the long-term follow-up was obtained in about 75% of the hips. The overall success rates in other studies ranged from 45% to 100% and in about two-thirds of these studies it was more than 75%.…”

Epidemiology of Developmental Dysplasia of the Hip: Analysis of Japanese National Database

“…1,2 Early detection and treatment of dislocation related to DDH (DDH-dislocation) are highly effective, with >80% success rates. [3][4][5][6] However, treatment outcomes in patients diagnosed with DDH-dislocation at the age of ≥1 year vary, 7,8 suggesting that early detection and treatment are essential for good outcomes in patients with DDH-dislocation. In the 1960s and 1970s, the incidence of DDH-dislocation in Japan was estimated at 1−3%.…”

Narrative Review of Complications Following DDH Treatment

“…The overall rate of ON in the entire study population, however, was less than 1%, leading to widespread adoption of this new "functional method" of treatment [18]. We found 16 studies to be included in this review [8][9][10][19][20][21][22][23][24][25][26][27][28][29][30][31]. Two large, multi-center studies have reported outcomes following Pavlik Harness treatment.…”

“…The overall rate of ON in the entire study population, however, was less than 1%, leading to widespread adoption of this new “functional method” of treatment [ 18 ]. We found 16 studies to be included in this review [ 8 – 10 , 19 – 31 ].…”