Follow up after successful Pavlik Harness treatment for DDH: is two years enough?

J Larwood, O Idowu, E Lindisfarne, K Elliott, A Aarvold

University Hospital Southampton NHS trust

There is a lack of clarity regarding the optimum duration for following up children treated successfully for developmental dysplasia of the hip in a Pavlik harness. The purpose of this study was to examine whether children with normal clinical and radiological findings at 2 years of age, ever show deterioration by 5 years of age.

Data was collected prospectively on all babies treated in Pavlik harness at our institution over an 18-month period, with follow up to five years. Demographic, clinical, and radiological parameters were recorded. Standard anterior-posterior radiographs of both hips were taken at 1, 2 and 5 years of age. A normal hip radiograph was defined as acetabular index (AI) within normal range adjusted for age, symmetrical and adequately sized ossific nuclei, and an IHDI grade of 1; plus a centre-edge angle greater than 20° on the radiograph taken at 5 years of age.

There were 170 hips (in 101 babies) successfully treated with a Pavlik harness and had radiographs available for analysis from 3 distinct time points of 1, 2 and 5 years of age. Of these, 92% of hips were radiologically normal at 2 years of age and 100% were radiologically normal at 5 years of age. Every child who had normal radiographs at age 2 years, had normal clinical and radiological examination at 5 years, with none having any intervention.

This study supports the BSCOS consensus that, following successful treatment with Pavlik harness, it is safe to discharge at 2 years of age. Longer follow up is not necessary if clinical and radiological parameters are normal at 2 years of age.