Pavlik Harness Teaching for Infant Hip Dysplasia
Critical Application and Timing Principles
The Pavlik harness must be applied correctly in the "human position" with frequent physician monitoring every 10-14 days, as improper application by the physician is the most common cause of treatment failure. 1
Optimal Timing and Efficacy
- Apply the harness before 6 weeks of age for maximum effectiveness, with success rates of 67-83% when used properly 2, 3
- The harness can be used up to 6 months of age, but efficacy decreases with increasing age 2
- Treatment should begin immediately upon diagnosis to prevent further acetabular underdevelopment 4
Proper Application and Positioning
Harness Setup
- Position the infant in the "human position" (flexion and abduction) to maintain concentric hip reduction 5
- Ensure high-quality harness construction, as poor-quality harnesses contribute to treatment failure 1
- The harness maintains the hip in a position that promotes acetabular development while allowing some controlled movement 6
Critical Teaching Points for Families
- Parents must receive written instructions on harness care and positioning to ensure proper healing 7
- The harness should be worn continuously (23-24 hours per day initially) unless specifically instructed otherwise by the physician 6
- Never force the legs into position or adjust straps without physician guidance 6
- Diaper changes should be performed with the harness in place 6
Monitoring Protocol
Physician Follow-up Schedule
- Schedule appointments every 10-14 days to check harness positioning and perform ultrasound monitoring 5
- The child must be examined frequently both in and out of the harness, clinically and with imaging 1
- Ultrasound is the preferred imaging modality during harness treatment to confirm concentric hip reduction and assess treatment response 2, 3
Recognition of Treatment Failure
- Failure to achieve reduction or adductor relaxation must be recognized promptly (within 3-4 weeks, not 3-5 months) and addressed immediately 1
- Predictors of failure include low post-reduction alpha angle, <20% femoral head coverage, bilateral cases, and Graf grade IV hips 3
- If reduction is not achieved within the first few weeks, alternative treatment should be considered 1
Duration and Weaning
Treatment Endpoint
- Continue treatment until ultrasound shows mature, well-developed hips comparable to Graf type Ia/b 5
- Treatment duration varies but typically ranges from 6-12 weeks for successful cases 6
- Gradual weaning from full-time to part-time wear is typically performed over several weeks 6
Post-Treatment Surveillance
- Obtain radiographs at or near conclusion of treatment (around 4-6 months of age) to document bony acetabular development and provide baseline for future surveillance 2
- Radiographs are not preferred during active harness treatment due to delayed ossific nucleus appearance and suboptimal positioning within the harness 2, 3
- Follow-up radiographs should be obtained at age 1 and 4 years to assess acetabular development 7, 3
- Continue clinical hip examinations at all well-child visits through age 5 years 7, 3
Common Pitfalls and Complications
Avoidance of Complications
- Avascular necrosis occurs in approximately 1% of hips treated with the Pavlik harness when proper protocols are followed 8
- Poor patient compliance contributes to treatment failure in some cases—emphasize importance of continuous wear to families 1
- Improper physician application and delayed recognition of failed reduction (waiting 3-5 months) are the most common preventable errors 1
Warning Signs for Families
- Skin irritation or breakdown under straps (requires immediate physician evaluation) 6
- Inability to maintain harness position despite proper application 6
- Development of asymmetric leg positioning or movement 6
Prognosis and Long-term Counseling
- When successfully treated with proper protocol and normal radiographs at age 2 years, long-term follow-up beyond age 5 may not be necessary 9
- Successful harness treatment restores normal hip development in the vast majority of cases 8
- Untreated or inadequately treated DDH leads to early degenerative joint disease, causing up to one-third of total hip arthroplasties in patients under 60 years 7, 3