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Our baby was born with dyplasia of the hip (just on one side). They put a special harness on her and we have used it faithfully. But now she developed pressure on the nerve so they had to take it off. We will try again in a few days. What happens if the harness causes the same problem again?
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Children born with developmental dysplasia of the hip (DDH) are often treated with a special device called the Pavlik harness. This canvas sling holds the child's hips and knees bent with the legs spread apart. But there can be complications with this treatment. One of those complications is a nerve palsy.
Developmental dysplasia of the hip (DDH), previously known as congenital hip dysplasia is a common disorder affecting infants and young children. The change in name reflects the fact that DDH is a developmental process that occurs over time. It develops either in utero (in the uterus) or during the first year of life. It may or may not be present at birth.
In this condition there is a disruption in the normal relationship between the head of the femur (thigh bone) and the acetabulum (hip socket). DDH can affect one or both hips. It can be mild to severe. In mild cases called unstable hip dysplasia, the hip is in the joint but easily dislocated. More involved cases are partially dislocated or completely dislocated. A partial dislocation is called a subluxation.
The idea of the Pavlik harness is to get the round head of the femur in close contact with the hip socket. This position helps the hip form a deeper socket that is less likely to dislocate. Many studies have been done now to show that this nonoperative approach to the problem is quite successful.
A recent study from the Texas Scottish Rite Hospital for Children might help answer your question. They looked back over records of the 1218 children treated at their clinic. All were treated with a Pavlik harness for developmental dysplasia of the hip. Less than three per cent developed a femoral nerve palsy.
The problem was handled by either adjusting the harness so the hips weren't flexed as much or the harness was removed until the nerve palsy went away and then reapplied with adjustments.
They found that children who responded quickly to the harness removal or adjustment were more likely to be treated successfully when the harness was reapplied. The longer it took for the nerve to recover, the less chance there was that the harness could be used. In fact, for children who still had some nerve loss after 29 days, there was no chance the harness would work. Fortunately, everyone did recover from the palsy.
You'll have a better idea what to expect after you see how long it takes for your child to recover fully from the nerve palsy. Once the necessary adjustments are made and the harness is refitted, there may be no further problems. Your orthopedic surgeon will guide you through this process step-by-step.
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