Pediatric Orthopedics

Depending on the child’s condition, the surgery may involve 1–3 incisions, each no longer than 8–10 cm. Although this is a major operation for a child, a successful surgery can provide lifelong benefits. Children usually recover quickly after surgery and may be able to walk in about 2–3 months.

Parents’ concerns are understandable, but after 18 months the bones and muscles have often adapted to a malpositioned hip. Forced closed reduction is usually unsuccessful and, even if achieved, carries a high risk of redislocation, possible secondary osteotomy, and increased pressure that may lead to femoral head necrosis.

Once the doctor has confirmed that the reduction was successful, a single fall or normal jumping and running will not immediately cause another dislocation. Parents do not need to worry that an active child will experience recurrent dislocation simply because they like to move.

For newborns, the harness should be applied once the diagnosis is confirmed. Although a Pavlik harness looks simple, fitting follows strict procedures and must be guided by a specialist. It is usually replaced every 3–4 weeks as the child grows. Ultrasound reassessment at 3 weeks checks hip reduction and stability; if reduction is not achieved, other treatment methods should be used.

About 90% of cases of developmental dysplasia of the hip at this age can be cured with a Pavlik harness. If the hip is completely dislocated from the acetabulum and the femoral head cannot be manually reduced by the doctor, Pavlik harness treatment is unlikely to succeed. If reduction is not achieved or the child is over 6 months old, closed reduction may be considered.