By Wee Ping Ngu
Developmental Dysplasia of the Hip (DDH) is a condition affecting 1/1000 new born babies and poses a serious threat to the normal development of the hip.
Complications range from back pain in later life to avascular necrosis of the femoral head. The Pavlik harness has long been the treatment of choice for DDH in babies from birth to 6 months. More often than not reduction of the hip and normal alignment is achieved within around 6-12 weeks. It is thought by some however that this treatment is more likely to fail in individuals with bilateral DDH involvement.
This study aimed to evaluate the effectiveness of the Pavlik harness in treating DDH in individuals who had both hips affected, and whether failure was more likely in bilateral than unilateral DDH.
A literature search was conducted using the Scopus platform to find papers relevant to the chosen topic. Titles, abstracts and texts were screened for relevance and 6 papers initially taken forward for review. A single paper was later removed due to it having no focus on bilaterality.
The structured review considered 5 papers all looking at the effect of bilateral DDH involvement on the success of Pavlik harness treatment. One paper claimed failure was 3.3 times more likely in bilateral DDH than unilateral with another quoting almost 6 times more likely. 2 other papers found there to be no statistically significant difference between the success of the Pavlik harness in bilateral and unilateral DDH. It was also found by one paper that bilaterality was a risk factor at the univariate level but not the multivariate.
This paper came to the conclusion, after in depth appraisal and comparison of the selected papers, that the harness is completely safe for those being treated for bilateral DDH and does not significantly increase the risk of failure of treatment in these patients. Recommendations for further study included improved study design and a large scale study of specifically the effect of bilateral DDH involvement in the failure of the Pavlik harness.