Management after application of the Pavlik harness in congenital dislocation of the hip.

The Pavlik harness was applied to a group of outpatients to treat CDH (group I), to a group of hospitalized patients (group II), and to a third group who received additional treatment to prevent avascular necrosis of the femoral head, based on the theory that the weight of the lower extremity plays an important role in the successful reduction by the Pavlik harness (group III). The results of the three groups were carefully compared in order to determine the ideal management of infants after application of the harness. No difference was found in the therapeutic results between group I and group III, when the reduction was attempted on the outpatient basis. However, the rates of reduction and anatomical healing were lower in the hospitalized patients of group III than in group II patients, but there was no difference in the incidence of avascular necrosis of the femoral head between the two groups. In the treatment of CDH using the Pavlik harness, application of the harness on the outpatient basis should be the first choice. It is fundamental to let the weight of the lower extremity help in effecting abduction of the hip joint, but the general and local reactions of the infant must be watched constantly, because too much pressure on the hip joint could invite avascular necrosis of the femoral head. If reduction at the outpatient clinic fails, the patient should be regarded as having the treatment-resistant type of CDH, and should be treated further with traction of the lower extremity, muscle release, and adjustment of the hip joint angle.