PAVLIK HARNESS FOR CONGENITAL HIP DISLOCA TION - LONG-TERM RESULTS

Purpose of the study After many years using Pavlik harness for treatme nt of congenital hips dislocation, it is important to evaluate long te rm results, failure causes and factors responsible for avascular necro sis. Material One hundred and forty one children were treated by this mean (159 dislocated hips, 30 acetabular dysplasia). The follow up was 74 months (12-175). Methods In this study, the severity of the disloc ation was evaluated by antero-posterior radiographs of the pelvis. The importance of proximal dislocation was measured by the distance from the top of the proximal femoral. metaphysis to the Y line and the late ralization by the distance from the medial border of the proximal femo ral metaphysis to the ischium. Results were appreciated using Severin classification modified by Kasser and Mose's circles. Several factors as age at the beginning of treatment, sex previous treatment, passive abduction of the hip, amount of dislocation were statistically evaluat ed (X(2) and P test). Results Of 159 dislocated hips, 10 (6,3 per cent ) were not reduced by the harness. Temporary growth modifications and avascular necrosis were observed in 24 (16.1 per cent) of 149 reduced hips. We shall add to these, 3 avascular necrosis in 10 hips which wer e not reduced in the pavlik harness and 2 avascular necrosis which occ urred in normal hips. This complication was not encountered in dysplas ic hips without dislocation. Using Severin classification, there was 6 1 excellent, 33 good and 5 fair results in the group of 99 hips follow ed for more than 72 months. Of all growth anomalies and avascular necr osis, only half of them keep sequelae at the last follow-up. Discussio n Some factors as age, sex, previous treatment have no incidence in th e number of failures and avascular necrosis. On the contrary, passive abduction of the hip, severity of the dislocation were responsible for most of these complications. Pavlik harness must be used with circons pection. It can be used. only where passive abduction is superior to 3 0 degrees and distance H superior to 4 mm. In other cases, it is prefe rable to use progressive traction. Conclusion Pavlik harness is widely used for treatment of congenital hip dislocation. Reduction can be ob tained as stabilisation and correction of acetabular dysplasia. The ri sk for avascular necrosis remains relatively high. The use of the harn ess needs a rigourous choice of indications.