Successful Pavlik Harness Treatment for Developmental Dysplasia of the Hip and Normal X-Ray at the Age of 2 Years: Is a Longer Follow-up Necessary?

Background: Management of developmental dysplasia of the hip (DDH) with a Pavlik harness is a well-known treatment. Follow-up until skeletal maturity is recommended as long-term studies mention late sequelae. The purpose of this study was to determine whether such a follow-up is necessary in patients treated successfully under a strict protocol. Methods: A retrospective review of a consecutive series of normal infants treated for DDH between January 1995 and July 2004 was undertaken. Only normal infants with frankly pathologic hips treated successfully with a Pavlik harness were included, and with a normal anteroposterior (AP) pelvis x-ray at the age of 2 years. All infants with any type of neurological disease, syndrome, other form of treatment for DDH, and failure of the Pavlik harness were excluded. At the last follow-up, a clinical examination and a standing AP pelvis x-ray were performed. Results: A total of 109 hips in 83 children were available for review. The mean follow-up was of 10 years and 2 months. All 109 hips had a normal clinical examination and a normal AP pelvis x-ray: a mean center-edge angle (CEA) of 29.5 degrees, SD +/- 4.1 degrees, a mean acetabular index (AI) of 1457 +/- 3.74 degrees, a mean Sharp's angle of 41.92 +/- 3.42 degrees, a Seringe-Severin score of IA, a normal teardrop figure, no signs of avascular necrosis, and Moses circles < 2. Conclusion: This study strongly suggests that in a selected group of patients treated for DDH with a Pavlik harness, under a strict protocol, and a normal x-ray at 2 years of age, a long-term follow-up is not necessary.