Pavlik Harness

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  • Pavlik harness is a dynamic flexion abduction orthosis used to treat DDH (Reduction & Maintenance) in infants up to 6 months of age.
  • Developed by Dr. Arnold Pavlik (Czechoslovakian Orthopaedic Surgeon) in 1944.
  • Spontaneous reduction of dislocated hip is promoted by positioning the hip in flexion while allowing free abduction. (i.e Prevents hip Adduction and Extension)


Parts of Pavlik Harness


  1. An adjustable band encircling the lower chest (Halter - Chest Strap).
  2. To this band are attached pair of shoulder straps which cross posteriorly and 
  3. A pair of stirrups which embrace the legs down to the heels. 
  4. The stirrups are suspended from the encircling chest band by two adjustable straps - one passing anterior to and the other posterior to the lower limb.

Indications: 

  • Infants with DDH & who are younger than six months.

Contra-Indications: 

  1. Infants with a "hip-click" but a normal physical exam (Barlow's test and Ortolani's test)
  2. Presence of teratologic hip dislocation.

Technique Of Application

  • Harness is applied with the child supine;

  1. Chest strap is applied first, allowing enough room for hand to be placed between the chest and the harness.
  2. Shoulder straps are buckled to maintain chest straps at nipple line; 
  3. Feet are then placed in the stirrups one at a time;
  4. Hip is reduced in flexion (90 to 120 deg), & anterior flexion strap is tightened to maintain this position; (transient femoral nerve palsy has been reported with hip flexion greater than 120 deg)
  5. Lateral strap is loosely fastened to limit adduction, not to force abduction (knees should be 3-5 cm apart at full adduction in harness)
  6. Posterior strap will maintain hip in safe zone but must not to force hip into abduction (to avoid the rare complication of AVN)
  7. Posterior straps should not be overtightened.

Visit the following link for a Video Tutorial of Pavlik Harness Application by the International Hip Dysplasia Institute

https://www.youtube.com/watch?v=MsV7cGrWpJU




Post Application Evaluation:


Barlow Test should be performed with in limits of harness to assure adequate stability;
  • Child is then placed in the prone position, & greater trochanters are palpated.
  • If an asymmetry is noted, a persistent dislocation is present.
Radiographs:
  • At 4 weeks post harness application, it is necessary to document the reduction (with x-rays taken in harness).
  • Femoral head should point to the triradiate cartilage with the hips held in flexion and abduction. 
MRI: may be indicated for infants between the ages of 4-6 months;

Ultrasound:

  • Ultrasound was superior to anteroposterior radiography for assessing hip position. generally the patient is left in the pavlik harness for a few weeks after the hip has stabilised in a reduced position, and subsequently part time abduction bracing should be used for several more weeks.

Harness usually leads to stability of reduced hip within 4 wks, but its use should be continued until clinical exam & x-rays of hip are normal.

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