Femoral Nerve Palsy as a Complication of Pavlik Harness Treatment for Developmental Dysplasia of the Hip: Ten-Year Prospective Study.

چکیده اصلی

BACKGROUND: Femoral nerve palsy (FNP) is a recognized complication of Pavlik harness (PH) treatment for developmental dysplasia of the hip (DDH), but its true incidence and clinical significance may be underestimated. This prospective study aims to determine the incidence, risk factors, and clinical course of FNP in infants undergoing PH treatment, and to evaluate whether FNP predicts treatment failure. METHODS: A 10-year prospective study (2015 to 2025) was conducted on all infants treated with a PH for Graf II to IV DDH at a specialist center. Patients were reviewed weekly with clinical and ultrasound assessment during the initial phase of treatment. Parents received structured education to facilitate early identification of FNP. Data collected included demographics, Graf type, age, weight, onset and duration of FNP, parental detection, management strategies, and final treatment outcome. RESULTS: Of 339 consecutive infants treated with a PH, 20 (5.89%) developed clinically evident FNP. Onset ranged from day 1 to 6 weeks, and 35% (n=7) were first identified by parents. All cases demonstrated full neurological recovery following harness adjustment or temporary cessation. PH treatment was successful in 65% of infants with FNP, compared with 93% in those without FNP. FNP occurred more frequently in older infants and in those with more severe DDH, with 16/20 cases involving at least 1 Graf III or IV hip. Traditional DDH risk factors showed no association. Treatment failure in the FNP cohort was confined to severe (Graf III/IV) dislocations. CONCLUSIONS: FNP is an important but reversible complication of PH treatment, with a prospective incidence of 5.89%. Older age at presentation, severe DDH (Graf III/IV), and possibly larger body habitus increase the risk of FNP. While FNP complicates management, it is not an independent predictor of PH failure; the primary determinant remains the severity of hip dysplasia. Early recognition, often by well-educated parents, and timely modification of PH settings allow most patients to continue successful nonoperative treatment. Individualized harness adjustment, rather than routine abandonment, is recommended to minimize nerve injury while preserving treatment success.

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