Conservative treatment of congenital dislocation of the hip in the newborn and infant.

Five practical questions, concerning which hips should be treated, method of treatment, duration of treatment, treatment failure, and whether pretreatment traction is advised in congenitally dislocated hips, are discussed and answered. All hips positive for Ortolani's sign, hips positive for Barlow's sign, dislocated and irreducible hips, and hips that appear unstable by sonography should be treated. A large number of studies document the safety and effectiveness of early treatment in the Pavlik harness. Treatment may be stopped at six weeks in the newborn and three or four weeks after stability is achieved in children three or four months old at the time of initial treatment. Sonography is helpful in determining when to stop treatment. Hips that fail Pavlik harness treatment are at risk to fail with other types of treatment as well and require a cautious approach. Traction before treatment of congenital dislocation of the hip (CDH) may not be necessary. Recent studies have shown that safe reductions may be performed without preliminary traction.