Do we know how to end the Pavlik Harness treatment?

Do we know how to end the Pavlik Harness treatment?

Which is better: completely stopping versus part time wearing of the Pavlik harness at the end of treatment?

Most doctors recommend continuing the Pavlik harness part-time at night and nap time for a few weeks after the hip looks normal on the ultrasound. However, some doctors just say take it off completely after full-time wear as long as the hip looks normal and feels normal. No one knows the best answer and a recent study tried to answer the question. (DJ Westacott, et al, J Pediatric Orthopedics B, March 2014)

Unfortunately, the study fell short of providing a clear answer. Two medical centers were compared where one stopped completely and the other center used weaning with part time wear. The infants in the weaning group averaged two more weeks of wear than the infants in the group that stopped all at once. This may not have been long enough to tell a difference, and there was not a statistically significant difference. However twice as many babies in the completely stop group needed another period of treatment later on, compared to the babies that were treated with a couple extra weeks of part time use of the harness – 8.3% versus 3.8%.

There may not have been enough babies in each group to show a statistically significant difference, but the trend seems to show that longer use is probably worthwhile. Another important detail is that stopping or weaning began when the ultrasound was normal for three weeks. Many orthopedic surgeons prefer the hips to be normal for six weeks before stopping or weaning from the harness. For babies with hip dysplasia, longer time in the harness may be the correct answer whether that time is full time or part time after the hip looks normal on ultrasound. Even then some babies will have a relapse so follow-up is needed.

For the babies with mild residual dysplasia, we highlighted a study last year about part time bracing. That study showed that wearing a brace during sleep at night and nap time seems to improve the outcomes of hip dysplasia. This adds support to part time wear for a few weeks even when the Pavlik harness has been successful. It’s a little extra insurance as long as the baby is sleeping well and tolerating the harness.

Summary: After the hip appears normal during treatment with the Pavlik harness, there are still some relapses whether the harness is stopped completely or worn part time for a couple more weeks. It’s probably better to continue the harness a little longer than to stop too soon. Part time wear is a good compromise for additional time in the harness towards the end of treatment.