The Pavlik harness can occasionally fail to reduce dislocated hips in babies with DDH especially in more severe cases. Previous studies have reported that abduction bracing after Pavlik harness failure is sometimes effective in achieving hip reduction, and rescues the dislocated hip from casting or surgery.
A recent study conducted at Children’s Hospital of Los Angeles found that rigid bracing couldn’t be expected to rescue the hip after the Pavlik harness failed. In this recent study, the average age at Pavlik harness initiation was 2.1 months (age range, newborn to 6 months) and patients spent an average of 1.2 months (range, 0.4 to 2.7 mo) in the harness before it was abandoned. After ultrasound demonstrated a persistently dislocated hip, patients were transitioned to an abduction brace and spent an average of 1.3 months (range, 0.1 to 3 mo) in the brace. None of those hips reduced with the change of bracing and all required further treatment with closed reduction and cast or with open surgical procedures. The good news is that all patients had stable hips at latest follow-up.
This series is not as hopeful as other studies that encourage switching to a different type of brace when the Pavlik harness is unsuccessful. However, in this study, the hips were stuck out of the socket while other studies included hips that would go in and out of the socket but just wouldn’t stay in the socket with the Pavlik harness. In those cases where the hip still goes in and out of the socket, it may be more successful to switch to a different type of brace, but in those that are more severe and are stuck out of the socket after trying a Pavlik harness, it may be better to move on to closed reduction and cast or surgery.
Comments: The IHDI currently has a Pavlik Harness research study being conducted to evaluate the success of Pavlik harness with hips that are stuck out of the socket compared to those that go in and out of the socket. Perhaps this and future studies will be more specific in determining what to do when the Pavlik harness is not successful. There do not seem to be any harmful effects of trying a different brace, and previous studies have shown some success so most doctors will probably continue to recommend a different brace if the Pavlik harness isn’t working and the hip dislocation is less severe.