The Pavlik harness is specially designed to gently position your baby’s hips so they are aligned in the joint, and to keep the hip joint secure. It is typically used to treat babies from birth to six months of age.
Since it is almost impossible to secure one hip by itself in the harness, both hips need to be positioned in the harness even if there is a problem with only one hip. By positioning your baby’s hips in such a way that the hip joint is aligned and stable, it will help normal growth and development of the hip joint. There are several reasons why the harness needs to be used and the doctor will explain to you why it is necessary for your baby to be in one.
When starting treatment, most doctors recommend that the baby wear the harness or brace full-time for 6-12 weeks. Some doctors allow the Pavlik harness to be removed for bathing and diaper changes as long as the legs are kept apart to keep the hips pointed at the socket. Babies are checked every week or two to adjust the fit, check the progress, and screen for complications such as femoral nerve palsy. The doctor can adjust the straps as needed to fit your baby as he or she grows. Ultrasound or x-rays are also used to see how the hips are developing.
Some orthopedic surgeons use the stress test to determine when it’s safe to discontinue the harness, others prefer to use the harness for a pre-determined amount of time because of concern that stress testing may prolong the period of time needed for the joint to become more stable. In cases where there is any doubt the Pavlik Harness can be discontinued and a fixed abduction brace may be substituted. There are some reports that this may speed the development of the hip better than continuing to use the Pavlik Harness.
If the treatment is working, after the hips become stable the harness or brace is worn part-time, usually at night, for another 4-6 weeks. Even after that, the baby may need to sleep in the harness or another brace for a few weeks as a safety measure.
These differences in treatment depend on physician preference and seem to lead to satisfactory results either way. The important thing is to determine whether the hip is located in the socket. If the hip remains dislocated longer than 4-6 weeks, then the Pavlik harness needs to be stopped because continuing to use the Pavlik harness when the hip remains dislocated is very harmful to the hip.
After appropriate and successful Pavlik harness treatment, there have not been any reported cases of re-dislocation. However, there is the risk of slow or incomplete development of the acetabulum (socket). This means that the hip will almost always stay in the socket, but the socket itself may become shallow or insufficient as the child grows. This is why x-rays are usually recommended for follow-up even when the harness has been successful. Once the x-ray is normal, then there’s probably a 99% chance that the hip will continue to grow normally. Recurrence of dysplasia is very rare after successful Pavlik harness treatment and a normal x-ray at 9-12 months old, but most doctors still recommend x-rays at an older age just to catch any shallow sockets that might need treatment to prevent early arthritis.
