[Treatment of congenital hip dislocation using Pavlik's harness. Long term results].
OBJECTIVE
After many years using Pavlik harness for treatment of congenital hips dislocation, it is important to evaluate long-term results, failure causes and factors responsible for avascular necrosis.


METHODS
One hundred and forty one children were treated by this mean (159 dislocated hips, 30 acetabular dysplasia). The follow up was 74 months (12-175).


METHODS
In this study, the severity of the dislocation was evaluated by antero-posterior radiographs of the pelvis. The importance of proximal dislocation was measured by the distance from the top of the proximal femoral metaphysis to the Y line and the lateralization by the distance from the medial border of the proximal femoral metaphysis to the ischium. Results were appreciated using Severin classification modified by Kasser and Mose's circles. Several factors as age at the beginning of treatment, sex, previous treatment, passive abduction of the hip, amount of dislocation were statistically evaluated (chi 2 and P test).


RESULTS
Of 159 dislocated hips, 10 (6.3 per cent) were not reduced by the harness. Temporary growth modifications and avascular necrosis were observed in 24 (16.1 per cent) of 149 reduced hips. We shall add to these, 3 avascular necrosis in 10 hips which were not reduced in the pavlik harness and 2 avascular necrosis which occurred in normal hips. This complication was not encountered in dysplasic hips without dislocation. Using Severin classification, there was 61 excellent, 33 good and 5 fair results in the group of 99 hips followed for more than 72 months. Of all growth anomalies and avascular necrosis, only half of them keep sequelae at the last follow-up.


CONCLUSIONS
Some factors as age, sex, previous treatment have no incidence in the number of failures and avascular necrosis. On the contrary, passive abduction of the hip, severity of the dislocation were responsible for most of these complications. Pavlik harness must be used with circonspection. It can be used only where passive abduction is superior to 30 degrees and distance H superior to 4 mm. In other cases, it is preferable to use progressive traction.


CONCLUSIONS
Pavlik harness is widely used for treatment of congenital hip dislocation. Reduction can be obtained as stabilisation and correction of acetabular dysplasia. The risk for avascular remains relatively high. The use of the harness needs a rigourous choice of indications.
Mafalda Santos
M
M
Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Paris.
Filipe
G
G
D000367:Age Factors; D003627:Data Interpretation, Statistical; D016267:External Fixators; D005260:Female; D005271:Femur Head Necrosis / Q000209:etiology; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009989:Orthotic Devices / Q000009:adverse effects; D011859:Radiography; D016059:Range of Motion, Articular; D012737:Sex Factors; D017211:Treatment Failure
Traitement de la luxation congénitale de hanche par le harnais de Pavlik. Résultats à long terme.