The Pavlik harness is more successful when started before the age of six months so most doctors are reluctant to try the Pavlik harness after that age. Also, the harness is usually abandoned if treatment is unsuccessful after four weeks because of concerns about causing greater problems if the harness is used on a dislocated hip that stays dislocated.
A recent report from the Netherlands has suggested that treatment may be successful in older infants. Van de Sande, et al. from Leiden University Medical Center, Netherlands treated 31 infants starting between age 5 months and 13 months. Average age was 8 months at time of diagnosis. 20 of the 31 hips (65 %) were successfully reduced with the Pavlik harness.
An average of 7 weeks (3-11 weeks) was needed to obtain the reduction. Additional bracing for 3-6 months was then used with an abduction brace.
The less severe dislocations were more successful. Tonnis Type 2 had 81% success but Tonnis Type 3 and 4 were only successful in 25% of patients. Five patients (15.0 %) developed radiological signs of osteonecrosis.
The authors concluded that prolonged use of the Pavlik harness in late-diagnosed hip dislocation (DDH) is acceptably safe and potentially successful for the infants in this older age group.
In a currently ongoing prospective study the IHDI group hopes to outline the factors associated with successful results in such cases, in good time.