Introduction:
The hip joint is a ball-and-socket type of joint formed between the ball end of the long-bone femur (thigh bone) and the cup-shaped cavity of the pelvis (hip bone). Hip dysplasia is the abnormality of the hip joint where the socket does not fully cover the ball, resulting in frequent hip joint dislocation. This condition is often congenital (birth defect), affecting babies and young children, and is known as developmental dysplasia of the hip. It can be corrected with early diagnosis and accurate treatment. The developmental dysplasia of the hip has an approximate incidence of four per 1000 live births and is more common in girls and firstborn babies.
What Is Pavlik Harness?
The Pavlik harness is a soft splint (medically termed an orthotic appliance) first used by Dr. Arnold Pavlik in 1944 to treat developmental dysplasia of the hip. The Pavlik harness has shoulder, chest, and leg straps that are fastened in the respective areas, and these straps are connected using two vertical straps in the front and the back. The front one is the flexion strap, and the back one is the abduction strap. The vertical straps are color-coded to identify the right and left sides. The appliance has sliders and buckles between the straps for adjusting the length and tightness. Pavlik harnesses are available in various sizes for the child’s age and growth. The primary goal of the Pavlik harness is to achieve spontaneous repositioning of the femur head inside the hip socket in a non-invasive and harmless way.
How to Wear the Pavlik Harness?
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The straps of the Pavlik harness are loosened and opened. The baby is laid over the appliance with the chest strap placed correctly around the chest. Adjust the chest straps in line with the nipples and secure them. A two-finger gap should be underneath the chest strap, allowing the baby to breathe freely.
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Next, lock up the shoulder straps with the chest strap with a single-finger gap underneath. The baby’s foot is inserted into the socks, and the leg straps are secured in a snug fit.
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Finally, the flexion and the abduction straps are threaded in the slider and buckle portion of the leg strap and fastened. There will be markings on the strap for adjustment convenience.
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The Pavlik harness should not be removed or adjusted until recommended by the health care provider. Special pillows and soft padding are available to keep the babies comfortable within the harness. The parents or the caregiver may enquire about it with the healthcare provider and use them according to their needs.
How Does Pavlik Harness Work?
Once the Pavlik harness is set and secured, the straps hold the baby’s leg apart and the knees in a bent position such that the head of the femur is kept inside the hip socket. The hip is kept and secured in a reduced position to allow the head of the femur to mold the hip socket. The Pavlik harness holds the hip in a controlled position of flexion and abduction (away from the midline). Unlike a plaster castor rigid braces, the Pavlik harness does not rigidly immobilize the hip but allows for controlled and limited movements.
The hip brace can be used in case of hip dislocation, which helps to reduce flexion and helps to hold the hip in position. Using a hip brace during dislocation prevents the hip from re-dislocation.
What Is the Use of the Pavlik Harness?
With the proper use of the Pavlik harness, spontaneous repositioning, spontaneous centralization of the femur head, and proper anatomical and functional healing of the hip joint can be achieved.
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Pavlik harness appliance is used to treat developmental dysplasia hip.
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Pavlik harness is also used in babies anticipating hip dislocation (the hip joint is in the correct place but can be displaced when stressed).
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Partial dislocation of the hip can be treated with a Pavlik harness.
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Pavlik harnesses can be used for femur fractures in babies younger than six months.
How Long Should a Child Wear Pavlik Harness?
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It is generally suggested that initially, the baby must be in a Pavlik harness for 23 to 24 hours. Parents or caregivers must learn to handle babies in this position for every activity, like cleaning, feeding, sponge bathing, changing clothes, and diapers.
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The physicians keep tracking the development of the hip using ultrasound.
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At a three-month scan, the physician may check for hip stability. If there is no improvement in the condition, the healthcare provider may opt for rigid braces therapy or surgery.
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If the condition is improving, the treatment is continued from six weeks to 12 weeks, depending on the child’s age, the severity of the disorder, and the treatment outcome. The total time of wearing the appliances is reduced gradually as the condition improves.
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Pavlik harness is contraindicated in babies with marked and severe hip dislocation (irreducible with manipulation) at the time of birth.
What Are the Risks Associated With Pavlik Harness?
Pavlik harness does not hurt, and babies can adjust quickly to wearing it. But sometimes complications do occur like:
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Avascular necrosis (bone death due to lack of blood supply) of the hip joint due to forced retention of the bones in the same position.
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Skin lesions, especially in the knee region. It is important to check for skin breakdown daily in the neck, groin, and knee.
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Damage to nerves in the leg (femoral nerve palsy).
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Lack of cooperation from family members.
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Downward displacement of the hip joint.
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Improper use of the appliance by the physician or the parents.
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Boy babies have a high risk of treatment failure with Pavlik harnesses.
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Bilateral involvement of hip dysplasia also exhibits a great risk of failure.
A dislocated hip can be fixed with the help of stretching or massage, but it is better to consult a doctor. Doctors help us to find the cause of subluxation and help us to prevent hip dislocation from recurring.
What Are the Care That Can Be Taken at Home?
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Placing the Harness: The orthotist will make sure the harness fits the baby properly and teach the parents how to place it properly in position.
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The Baby Should Get Used to the Harness: It usually takes two to three days for a baby to adapt to the harness. Some may cry a little in the initial stages, but slowly, they will get adapted.
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Hygiene and Skin Care Routine: The skin of the baby needs to be monitored regularly. If there is any redness or irritation, it needs to be discussed with the orthotist.
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Nappies and Clothing: Usually, normal nappies can be worn, but changing both feet should not be helped together as it can change the position of the hip.
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Feeding: The baby can be fed while wearing the harness, but the proper position should be found.
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Cleaning the Harness: The harness should be washed and cleaned only if necessary.
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Other Issues: Femoral nerve palsy is a common issue the baby faces while using the harness. If the baby stops kicking, it should be discussed with the orthotist immediately.
Conclusion:
With the Pavlik harness, safe and effective hip joint repositioning can be achieved by meticulous attention and appropriate ultrasound monitoring. The treatment success of developmental dysplasia of the hip highly depends on the baby's age. Research shows the success rate of Pavlik harness treatment is between 80 and 97 percent. If Pavlik harness therapy is started in babies within seven weeks of age, there is a great success in treatment outcomes. Most children will have normal hip development after the Pavlik harness treatment.
