In the child beyond 6 months, it may not be possible to reduce the hip in a Pavlik harness alone. In these cases, the child may need to be admitted to the hospital and closed reduction performed under general anesthetic. Sometimes a period of leg traction may be needed to facilitate the reduction. Following the reduction, the child is placed in a hip spica cast for about 3 months, followed by the use of a removeable hip abduction brace for another 3 months after that. In a child older that 1 year, closed reduction alone may not be possible.
Open reduction becomes necessary.
This involves making an incision to expose the hip at surgery, reducing the hip under direct vision, and stabilizing the hip by reinforcing the hip capsule. The child is then placed in a hip spica cast. In some cases, the hip may redislocate, or continues to stay dysplastic. With successful treatment, the hips develop normally, and no long-term problems need be expected. For the child discovered to have hip dysplasia later in infancy, treatment is more prolonged or complicated, but good results with a normal hip can be expected.