MANAGEMENT OF DISLOCATED HIPS WITH PAVLIK HARNESS TREATMENT AND ULTRASOUND MONITORING

We studied the outcome of ultrasound-monitored Pavlik harness treatmen t of 47 infants (nine boys and 38 girls) with 55 frankly dislocated hi ps documented by dynamic ultrasonography. The success and failure grou ps were of similar ultrasound status (hip-status score) at the time of initial examination, but a significant difference emerged at the 7- a nd 14-day examinations. Detection of frank dislocation and institution of treatment with the Pavlik harness within 3 weeks of birth increase d the probability of a successful result. Of 33 infants (27 girls and six boys) with 41 dislocated hips who were seen before the age of 21 d ays, 26 (63%) hips were reducible in the Pavlik harness alone, and 15 (37%) hips were irreducible and required a subsequent procedure to ach ieve reduction. Fourteen infants (three boys and 11 girls) with 14 dis located hips were first seen after the age of 21 days. Three (20%) wer e successfully treated in the Pavlik harness alone, and 11 (80%) requi red further treatment. In our opinion, persistent dislocation without improvement after 3 weeks of treatment in the Pavlik harness mandates discontinuation of use of this device. No anatomic factors were seen a t the time of the initial ultrasound examination that permitted predic tion of those hips likely to succeed or fail treatment with the Pavlik harness.