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Avoiding Avascular Necrosis in Developmental Dysplasia of the Hip

Infants and very young children with developmental dyplasia of the hip (DDH) are usually treated with a Pavlik harness with good results. A Pavlik harness holds the child in a position with the hips bent and apart. This position keeps the hip in the socket until it stabilizes. Surgery may be needed if this treatment fails to keep the hip in place.

Using traction to pull the leg down and position the head of the femur (thighbone) in the socket is called closed reduction. If that fails, an operation called an open reduction to put the hip back in its socket may be done. Parents and doctors want to know when is the best time to do the surgery?

The authors of this article test the idea that early hip reduction is the best way to avoid a condition called avascular necrosis (AVN). AVN is a loss of blood supply to the hip with bone death. It is a serious complication after DDH. It can lead to joint deformity, a difference in leg length, and problems with walking.

All patients in the study were diagnosed within two months of birth with DDH. Treatment by Pavlik harness failed to reduce or stabilize the hip. Most of the children were then treated with closed reduction by the time they were three months old. Two patients had open reduction.

In a very small number of patients, DDH persisted and a second operation was needed. AVN did not occur in any of the hips treated in the first three months of life with reduction. The results support the authors' theory that the risk of AVN is decreased after failed Pavlik harness treatment with early hip reduction.

References: 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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