A very important scientific paper has been published, and one of the co-authors is a member of the IHDI Medical Advisory Board. After initial treatment with a Pavlik harness, the child sometimes has mild dysplasia that doesn’t seem to want to go away. The hip remains “borderline” and the doctor may recommend observation or part-time bracing with a rigid abduction brace. Some children also are diagnosed after six months of age with mild dysplasia and the doctors are in the same dilemma of wait-and-see or treat part-time with a brace. This research study sheds light on the value of part-time bracing when mild dysplasia remains after age six months. Usually, the brace is worn while the child is sleeping for naps and night time.
The report by I. Gans, John M. Flynn, and Wudbhav N Sahkar (Medical Advisory Board member) was just published in the Journal of Pediatric Orthopedics. The researchers studied 39 hips that were braced and 31 hips that were not braced for mild residual dysplasia in the age group from 6 months to 1 year of age. The braces were worn only while sleeping for naps and night time. The braced group had significantly better hips at follow-up than the unbraced infants.
Comment: This study is important because as many as ⅓ of babies treated with a Pavlik harness will have residual dysplasia following initial treatment. Doctors have had little guidance to help them decide whether to continue part-time treatment or to wait and see what happens even though it’s known that some children will continue to have hip dysplasia. This study supports treatment at night and nap time for several months when there is remaining dysplasia. It still remains to be seen whether this also applies to children older than one year of age who have residual dysplasia after treatment with closed reduction and casting. An older study published in 1979 (JR Lindstrom, et.al. JBJS-Am 61:112-8) used found that dysplasia of the socket improved as long as the hip was centered in the socket and was treated with part-time bracing.