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. 2019 Jul 2;16(5):440-444.
doi: 10.1016/j.jor.2019.06.027. eCollection 2019 Sep-Oct.

Comparison of Pavlik Harness treatment regimens for reduced but dislocatable (Barlow positive) hips in infantile DDH

David Neal  1 , Terri Beckwith  2 , Adam Hines  3 , Wei Chun Lee  4 , Bekir Eray Kilinc  5 , ChanHee Jo  2 , Harry Kim  2   6
Affiliations

Comparison of Pavlik Harness treatment regimens for reduced but dislocatable (Barlow positive) hips in infantile DDH

David Neal et al. J Orthop. .

Abstract

Objective: Although the Pavlik Harness (PH) is the most utilized treatment for developmental dysplasia of the hip (DDH), the ideal treatment protocol (frequency of clinic visits in the first month and daily wear duration) for Barlow ​+ ​hips (reduced but dislocatable) has yet to be defined.

Methods: This study compared DDH patients with Barlow hips who were treated with 23 vs 24 h per day PH wear and weekly vs every other week visits. Clinical success was defined as a stable hip that did not require closed or open reduction, or the use of an abduction orthosis prior to achieving clinical stability. Radiographic success was based on the acetabular index at 2-year follow up.

Results: Sixty-five patients (75 hips/58 females) with Barlow hips had a mean age of presentation of 15 ± 12 days (range 4-70) and mean follow-up of 33 ± 17 months (range 6-90). There was no difference in clinical or radiographic success rate between 23 h vs 24 h wear groups (p > 0.99 both) or the Frequently vs Infrequent visit groups (p = 0.49 both). Overall clinical success rate was 97% (73/75 hips) and radiographic success rate at 2 years was 97% (58/60 hips).

Conclusion: A strict, weekly clinic visit and 24-h PH regimen may not be necessary to obtain good clinical and radiographic outcomes in infants presenting <6 months of age with Barlow positive hips.

Level of evidence: Therapeutic, Level III.

Keywords: Barlow positive hip; DDH; Developmental dysplasia of the hip; Pavlik harness.

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Figures

Fig. 1
Fig. 1
Eight week old girl with a left Barlow positive hip dislocation treated with 24 h PH wear regimen and less frequent clinic visits. A. A non-stress coronal view of pre-treatment left hip ultrasound. B. A standing AP radiograph of pelvis obtained at 26 months showing normal left hip.
Fig. 2
Fig. 2
Six week old girl with a left Barlow positive hip dislocation treated with 24 h PH wear regimen and frequent clinic visits. A. A non-stress coronal view of pre-treatment left hip ultrasound. B. A standing AP radiograph of pelvis obtained at 25 months showing a normal left hip.
Fig. 3
Fig. 3
Eight week old girl with a right Barlow positive hip dislocation treated with 23 h PH wear regimen and less frequent clinic visits. A. A non-stress coronal view of pre-treatment right hip ultrasound. B. A standing AP radiograph of pelvis obtained at 25 months showing a normal right hip.
Fig. 4
Fig. 4
Four week old girl with a left Barlow positive hip dislocation treated with 23 h PH wear regimen and frequent clinic visits. A. A non-stress coronal view of pre-treatment left hip ultrasound. B. A standing AP radiograph of pelvis obtained at 21 months showing a normal left hip.
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