Follow-up after successful treatment for developmental dysplasia of the hip using a Pavlik harness : is two years enough?

Abstract

The length of time for which children, who are treated successfully for developmental dysplasia of the hip (DDH) in a Pavlik harness should be followed up, remains uncertain. The aim of this study was to examine whether children who are treated in this way, who have normal clinical and radiological findings at the age of two years, can be safely discharged from routine follow-up. Data were collected prospectively on all 101 children (170 hips) who were treated in a Pavlik harness in our children's hospital between January 2015 and June 2016, with follow-up to the age of five years. Demographic, clinical, and radiological parameters were recorded. Routine anteroposterior radiographs of both hips were taken at the age of one, two and five years. A normal radiograph of the hip was defined as one with an acetabular index (AI) within the normal range when adjusted for age, symmetrical and adequately sized ossific nuclei, an International Hip Dysplasia Institute grade of 1 and a centre-edge angle (CEA) of > 20°. Of the 101 children (170 hips) who were successfully treated in this way and had radiographs available for analysis from the three timepoints, 157 hips (92%) were normal radiologically at the age of two years and all were normal radiologically at the age of five years. Every child who had normal radiographs at the age of two years had normal clinical and radiological findings at five years, with none having any intervention. These findings support the suggestion that, following successful treatment with a Pavlik harness, children with DDH can be safely discharged from the clinic, assuming that they are clinically and radiologically normal, at the age of two years instead of five.