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Femoral Nerve Palsy in Pavlik Harness Treatment for Developmental Dysplasia of the Hip

Murnaghan, M. Lucas MD, MEd, FRCSC; Browne, Richard H. PhD; Sucato, Daniel J. MD, MS; Birch, John MD, FRCSC

Journal of Bone & Joint Surgery - American Volume: 2 March 2011 - Volume 93 - Issue 5 - p 493–499
doi: 10.2106/JBJS.J.01210
Scientific Articles

Background: Transient femoral nerve palsy is a potential complication of the use of a Pavlik harness to treat developmental dysplasia of the hip. Our hypothesis was that patients who develop a femoral nerve palsy while undergoing Pavlik harness treatment for developmental dysplasia of the hip are more likely to have unsuccessful orthotic treatment and to require closed or open hip reduction.

Methods: We performed a retrospective review of all patients who underwent Pavlik harness treatment for developmental dysplasia of the hip within a seventeen-year period (1992 to 2008). All cases of femoral nerve palsy were identified and reviewed. Thirty infants met the study criteria and formed the palsy group. A control group of seventy-nine infants who did not develop femoral nerve palsy during treatment was randomly selected.

Results: Thirty cases of femoral nerve palsy were identified from a group of 1218 patients for an incidence of 2.5%. Eighty-seven percent of femoral nerve palsies presented within one week of application of the Pavlik harness. Femoral nerve palsy was more likely in older, larger patients in whom the developmental dysplasia of the hip was of higher severity. Patients whose femoral nerve palsy resolved within three days had a 70% chance of having successful treatment with the Pavlik harness, whereas those who had not recovered by ten days had a 70% chance of having treatment failure with the Pavlik harness. The success rate associated with treatment with a Pavlik harness was 94% in our control group and 47% in our palsy group.

Conclusions: Femoral nerve palsy is an uncommon yet clinically important complication of Pavlik harness treatment for developmental dysplasia of the hip. This complication is strongly predictive of failure of treatment, and its impact is greatest when the developmental dysplasia of the hip is higher in severity. Early recognition and management of femoral nerve palsies may improve the success of treatment.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

1The Hospital for Sick Children, Room S-107 Elm Wing, 555 University Avenue, Toronto, ON M5G 1X8, Canada. E-mail address: lucas.murnaghan@sickkids.ca

2Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219

Copyright 2011 by The Journal of Bone and Joint Surgery, Incorporated
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