Child Orthopedics

Frequently Asked Questions

Our baby was born with hip dysplasia. She's been wearing a Pavlik harness for two months but there's been no change in her condition. We're concerned that it's not working. Should we go ahead and have the surgery to put the hip back in place? What happens if we wait? How long can we wait?

You ask good questions that there may not be complete answers to as yet. Orthopedic surgeons debate the best timing of treatment for developmental dysplasia of the hip (DDH).

Some say treatment should be delayed until the growth center of the femoral head (top of the thigh bone) is developed. This area is called the ossific center. It has a protective effect on the hip to keep the blood flow going. Without it, the child is at risk for avascular necrosis (AVN) or death of the bone from a lack of blood.

There are experts who disagree. They say it doesn't matter if the ossific center isn't there. Early treatment is best because it gives the joint a longer chance to remodel and shape the femoral head in the hip socket. The hip that is in the center with a round head and socket will have the best results in the long run.

A recent study from the Alfred I. duPont Hospital for Children in Delaware reports the results of early treatment for DDH after Pavlik harness failure. Children who had either an open or closed reduction of the hip before the age of three months had no AVN.

Delaying the surgery may protect the femoral head from loss of blood supply from excess compressive force. But the risk of AVN goes up with time delays and reduces the remodeling potential of the hip. There is less chance for normal growth and development.

According to the results of the duPont study, reducing the hip at the earliest opportunity can help prevent irreversible degenerative changes later.

Hakan Senaran, MD, et al. Avascular Necrosis Rate in Early Reduction After Failed Pavlik Harness Treatment of Developmental Dysplasia of the Hip. In Journal of Pediatric Orthopedics. March 2007. Vol. 27. No. 2. Pp. 192-197.

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