Child Orthopedics


Frequently Asked Questions

Our grandson was born with a slightly dislocated hip. They've put him in an awful harness-thing that looks very uncomfortable. Is this really necessary? I babysit him three days a week, and I just can't bear to see him in that contraption. Can I take it off at least while he's sleeping?

It's likely that your grandson has a condition called developmental dysplasia of the hip (DDH). DDH represents a group of hip disorders involving partial or complete dislocation of the femoral head. The femoral head is a round ball of bone at the top of the femur or thigh bone. Normally, it fits inside the acetabulum (hip socket). But with DDH, the femoral head slips partially or completely out of the socket. Treatment for this problem begins with the Pavlik harness. This device holds the child's hips and knees in a position of flexion. The hips are also abducted (held wide apart). While wearing the harness, the child cannot straighten the legs, which means he or she cannot extend the hip. The goal is to keep the femoral head in the socket and keep it from shifting or slipping out of the acetabulum. Studies show that it works. Without it, your grandson may end up needed invasive surgery with all the risks that can go with that. For best results, the child must wear the Pavlik harness 23.5 hours a day for at least three weeks. It is removed only to bathe the child. At the end of three weeks, ultrasound studies and possibly X-rays are done to see how stable the hip is. If the hip is staying in the hip socket nicely, then the child wears the harness for another three months. If the hip(s) are still stable at the end of 90-days, then the time the harness is on can be slowly reduced until the child is only wearing it at night and for naps. After another couple of months, it can be discontinued altogether. The success of this program depends on understanding what's wrong and why this treatment is so important. Parents, grandparents, and other caregivers must be tuned in to what is going on and follow the doctor's recommendations closely. Using the Pavlik harness correctly and consistently is absolutely essential. It's only temporary. Anything less can result in complications and problems requiring surgery.

Vineeta T. Swaroop, MD, and Scott J. Mubarak, MD. Difficult-to-Treat Ortolani-Positive Hip: Improved Success with New Treatment Protocol. In Journal of Pediatric Orthopaedics. April/May 2009. Vol. 29. No. 3. Pp. 224-230.

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