The effect of pavlik harness use on the success of closed reduction in patients with developmental dysplasia of the hip

Purpose: The aim of this study is to investigate the effect of Pavlik harness compliance on the success of closed reduction in patients who underwent closed reduction and pelvipedal cast application after the use of Pavlik harness. At the same time, to compare the treatment results of patients who did not use a Pavlik harness and underwent direct closed reduction with those who used a Pavlik harness. Materials and Methods: In this study, the medical records of DDH patients who underwent Closed Reduction between January 2020 and June 2021 at Harran University Faculty of Medicine Hospital Orthopedics and Traumatology Clinic were retrospectively examined. Patients who were treated and followed up by our clinic within the specified date range and who underwent closed reduction before 12 months were included in the study. A total of 106 patients were identified, for whom a direct closed reduction decision was made after the exclusion criteria were applied, and a closed reduction was applied when success was not achieved as a result of the use of the Pavlik harness. After the patients with uncompliance with regular hospital visits were excluded from study, 148 hips of 87 patients were included in the study. Acetabular Index (AI) value and IHDI degree were measured on the patients' pelvic AP radiographs taken before CR. When the cast was removed in the 3rd month after CR, AI and IHDI degrees were measured in the 6th month of treatment. Patients who lost reduction within one year and required additional surgical procedures were considered as treatment failure. Results: Of the patients included in the study, 8 were male and 79 were female. There was isolated right side involvement in 6 of them, left side involvement in 18 cases, and bilateral involvement in 63 cases. There was a history of swaddling in 65 of 87 patients (74.7%). There was a consanguineous relationship between the parents of 39 of the patients (44.8%). 32 of them (36.8%) had a family history of DDH. Of the 148 hips that underwent CR, 136 hips (91.9%) were evaluated as "successful", and 12 hips (8.1%) were evaluated as "failure" because reduction was lost within 1 year after the procedure and open reduction was required. When the groups were evaluated, 4 of 6 hips (6.1%) that did not use Pavlik harness at all, 6 of 26 hips (23.1%) that did not use Pavlik harness appropriately, and 2 of 56 hips (3.8%) that used Pavlik harness appropriately were considered unsuccessful. In the patients included in the study, 88 hips were classified as IHDI 2, 43 hips as IHDI 3 and 17 hips as IHDI 4. The number of hips that failed according to the groups was 3, 1 and 8, respectively. 3.4% of hips with IHDI 2, 2.3% of hips with IHDI 3, and 47% of hips with IHDI 4 were considered as failed closed reduction. Conclusion: We found that improper use of the Pavlik harness and long-term use reduce the success of CR. Since there was no significant difference between the CR success of the group that never used the Pavlik harness and the group that used it appropriately, we concluded that not using the Pavlik harness at all is healthier than using it improperly in terms of its effect on the CR success. Keywords: Pavlik harness, Closed reduction, Pavlik harness compliance. displasia