Effect of Pavlik harness on motor developmental milestones: Comment on a study by Ucpunar et al

The growth of the femoral epiphysis and acetabulum is affected by developmental dysplasia of the hip due to the absence of the femoral epiphysis in its orthotopic location. ¹ Pavlik harness is the treatment of choice in the initial 6 months and it is during this period major developmental milestones are gained which prepares the child for sitting with support as well as independent sitting. In this regard, the study by Ucpunar was read with interest. ² The study assessed treatment initiation age, treatment duration and age of achieving independent sitting and walking. A significant correlation was noted between the treatment duration and the age at which the milestones were achieved.

The mean duration of the harness in the study was 4.6 ± 2 months, roughly translating to more than 16 weeks on average. Pavlik harness is classically used for a maximum of 4 weeks for types D, III and IV and a maximum of 8 weeks for types IIa, IIb and IIc in the initial trial period. ³ No details have been mentioned regarding the gradual change in the type of hip as treatment progressed which necessitated the increased period of usage of the harness. A correlation between the Graf stages and age of initiation of the motor milestone under investigation would have provided more comprehensive results which would enable the healthcare provider to prognosticate the parents.

Similarly, age has been quoted as a significant factor in the success of Pavlik treatment. Evidence is conflicting as age increases. Both a failure rate of 76% and a success rate of 82% are reported after the age of 4 months.^4,5 Since the current study mentions the inclusion of children above the age of 3 months, a subgroup analysis based on the age of initiation of treatment could have provided evidence regarding the effect of it on the age of attainment of milestones.

We congratulate the authors for this study which has looked into an important aspect of a child’s growth that had been hitherto not explored. The results of this study shall help healthcare providers to prognosticate the parents. A prospective study with a more detailed subgroup analysis based on the staging of the hip and the age of initiation of treatment will provide more valid information.