Ernest L. Sink

Background: Recent literature has found failed hip arthroscopy to be associated with worse short-term outcomes after periacetabular osteotomy (PAO). This study aimed to assess its relationship with mid-term PAO outcomes. Methods: Patients with acetabular dysplasia undergoing isolated PAO with or without concomitant hip arthroscopy between 2016 and 2020 were identified. Patients with minimum 2-year follow-up from their most recent PAO with PROMs were included (161 patients, 216 hips). Patients were placed into the PREVSCOPE group, consisting of those who had undergone hip arthroscopy before PAO (47 patients, 52 hips), or the PAOALONE group, consisting of patients who had not (114 patients, 164 hips). The modified Harris Hip Score (mHHS) and International Hip Outcome Tool-12 (iHOT-12) were assessed. The MCID was defined as an outcome change ≥ 18 for mHHS and ≥ 26 for iHOT-12. PASS was defined as a postoperative score of ≥ 71 for mHHS and ≥ 65 for iHOT-12. Radiographic parameters were analyzed by hip, while PROMs were analyzed by patient. Results: The mean preoperative lateral center edge angle was higher (p < 0.001), and the mean alpha angle was lower (p < 0.001) in the PREVSCOPE group. There was no difference in Tönnis grade, femoral version, or acetabular version between groups. Mean follow-up was 6 ± 2 years for both groups. There was no difference in mean preoperative mHHS or iHOT-12 scores. When controlling for prior failed arthroscopy, anatomical factors, age, BMI, preoperative PROMs, and procedure number, no differences were found in PASS or MCID rates for mHHS or iHOT-12 between groups. Conclusion: This study found failed hip arthroscopy was not associated with worse PAO outcomes at mid-term follow-up. Surgeons can be confident offering PAO to appropriately selected patients regardless of prior arthroscopy; however, these patients should be made aware of the potentially slower recovery.

Maximal outcome improvement (MOI), the percentage of total possible patient-reported outcome measure (PROM) score improvement from baseline, is increasingly being used to describe clinical significance of PROMs. This study defines MOI thresholds for the modified Harris Hip Score (mHHS) and International Hip Outcome Tool-12 (iHOT-12) after periacetabular osteotomy (PAO), determines the proportions of threshold achievement, and identifies the predictors of threshold achievement. We analysed 317 patients who underwent PAO for symptomatic acetabular dysplasia with pre- and postoperative PROMs; postoperative surveys were collected at 1–2 years follow-up. MOI thresholds were calculated with receiver operating characteristic curves. Multivariable logistic regression determined predictors of achieving thresholds using pre- and intraoperative characteristics. MOI thresholds were 47.1% (mHHS) and 50.1% (iHOT-12). Proportions of threshold achievement were 63.1% (mHHS), 61.8% (iHOT-12), and 71.0% (either PROM). Variables with increased risk of failing to achieve thresholds were: mHHS–PAO as revision (OR = 2.51, 95% CI = 1.33–4.76, P < .01), higher preoperative lateral centre-edge angle (OR = 1.06, 95% CI = 1.01–1.12, P = .03), and higher Tönnis grade (OR = 1.90, 95% CI = 1.09–3.30, P = .03); iHOT-12–PAO as revision (OR = 2.30, 95% CI = 1.25–4.26, P < .01), increased body mass index (OR = 1.08, 95% CI = 1.01–1.16, P = .04), and concomitant anterior inferior iliac spine/subspine resection/decompression (OR = 1.81, 95% CI = 1.01–3.26, P = .046). Although newer, MOI provides essential information for contextualizing a patient’s recovery course when used alongside other clinical thresholds.

Background: Developmental hip dysplasia (DDH) is now considered the primary cause of early hip arthritis. Complications of missed or delayed DDH may be minimized with early diagnosis and effective nonoperative interventions. The standard of care in the United States for detecting DDH is selective screening whereby ultrasound is only performed in infants with an abnormal physical examination or risk factors. A cost-effectiveness analysis, considering health utilities and lifespan costs, is warranted. Methods: A Markov model was designed comparing 7 DDH screening strategies: Universal ultrasound screening at birth 2 weeks (USB); selective ultrasound screening at birth/2 weeks (SSB); universal ultrasound screening at 6 weeks (US6); selective ultrasound at 6 weeks (SS6); universal hybrid screening with ultrasound birth 2 weeks for positive examination and at 6 weeks for all others (UHS); a German national model with ultrasound at birth/2 weeks for instability or risk factors and all others at 6 weeks; and a no ultrasound screening. A literature review captured relevant probabilities, costs, and incidences. Society and payer perspectives were analyzed. Deterministic and probabilistic sensitivity analyses were used. Results: From a societal perspective, US6 was more effective (77.08 vs. 77.06 quality-adjusted life years (QALYs)) yet minimally more costly ($5,629.68 vs. $5,471.50) than SS6. Using a willingness-to-pay threshold of <$100,000/QALY, US6 was more cost-effective than SS6 (incremental cost effectiveness ratio [ICER] = $7,833.45/QALY). From the payer perspective, US6 was again cost-effective relative to SS6 (ICER = $8,224.57/QALY). US6 was overall cost-effective (<$100,000/QALY) in 50.4% of 10,000 probabilistic sensitivity analysis iterations assessing societal costs (vs. 20.8% UHS, 13.2% SS6, 12.6% German, 2.6% USB, and 0.5% SSB) and 50.7% of payer iterations (vs. 21.0% UHS, 13.4% SS6, 12.3% German, 2.3% USB, and 0.4% SSB). UHS was the second most cost-effective (77.06 QALYs, societal = $5,668.58, payer = $4,351.63). Differences in mean costs and QALYs among leading strategies were small. Conclusion: US6 was the most cost-effective strategy in the base case from both societal and payer perspectives. Given small differences in mean costs and QALYs among leading strategies, implementation feasibility and outcome distribution may be important policy considerations in the US context. A UHS strategy may represent a pragmatic pathway for adoption while preserving broader detection benefits. Level of Evidence: III . See Instructions for Authors for a complete description of levels of evidence.

Background: A strong association exists between outcomes of orthopaedic surgery and patients' preoperative mental health. Therefore, population-wide trends and changes in well-being are of great interest to providers. We sought to describe the well-being among patients undergoing orthopaedic surgery before, during, and after the pandemic. Methods: Patients who underwent an orthopaedic surgical procedure at 1 specialty hospital in New York City between 2019 and August 2024 were split into prepandemic, pandemic, and postpandemic groups (n = 129,677). Preoperative Patient-Reported Outcome Measurement Information System Scale v1.2-Global Health (PROMIS-GH) mental health (MH) and physical health (PH) scores were analyzed in addition to the proportion of patients with low MH and PH. Demographic and clinical factors associated with low MH/PH were identified. Results: Median PROMIS MH and PH scores declined in the pandemic cohort and remained decreased in the postpandemic cohort. Compared with the prepandemic cohort, the proportion of patients with low MH increased in the pandemic cohort (11% vs. 5%) and increased further in the postpandemic cohort (14%). Compared with the prepandemic cohort, the proportion of patients with low PH increased in the pandemic cohort (37% vs. 25%) and increased further in the postpandemic cohort (40%). Relative to the prepandemic period, the odds of low MH adjusted for demographic, clinical, and social factors were 2.70 for the pandemic period and 3.46 for the postpandemic period; for low PH 1.95 and 2.21, respectively. Factors associated with low MH/PH included preoperative comorbidities, age, sex, ethnicity, insurance type, socioeconomic status, and surgery within the spine service. Conclusion: Our results suggest that mental and physical health among patients undergoing orthopaedic surgery in New York City worsened during the pandemic. In the postpandemic period, mental and physical health has continued to decline with a higher proportion of low MH and low PH compared with prepandemic and pandemic levels. The persistent decline observed past the pandemic period indicates that long-term social and societal factors may be associated with population-wide changes in psychosocial functioning rather than exclusively pandemic-specific determinants. In response to this negative trend, surgeons and institutions should consider additional preoperative supports for patients with diminished well-being. Level of Evidence: Level III —Retrospective cohort study. See Instructions for Authors for a complete description of levels of evidence.

Patients electively undergo the treatment of symptomatic acetabular dysplasia by periacetabular osteotomy (PAO). Increasing evidence suggests that a patient’s perception of success following orthopaedic surgery is influenced by their preoperative expectations. In response, the Hip Preservation Surgery Expectations Survey (HPSES) was developed to quantify improvement expected and received in domains of pain, function, and psychological well-being. This instrument has not yet been evaluated in a hip preservation sample postoperatively, consistent with a paucity in the literature regarding patient-derived goals. Therefore, the purpose of this study was to describe the fulfilment of expectations following PAO through the HPSES and collection of preoperative personal goals. Preoperatively and at 1-year, 80 participants undergoing PAO (mean age 27.5 ± 9.2 years, 98.8% female) completed the HPSES and/or personal goals surveys. A proportion was calculated as the amount of improvement received versus the amount of improvement expected. The average expectations proportional score was 0.97 with 51.6% achieving a proportional score ≥ 1.0. The average goals proportional score was 0.91 with 50.0% achieving a proportional score ≥ 1.0. Expectations and goals related to day-to-day function, social activity, routine exercise, and relieving stress and anxiety were met most often and correlated to improvement and satisfaction scores. Goals related to high-level physical activity and pregnancy were met less often. Higher preoperative expectations and less attainable goals were associated with lower fulfilment. The appraisal and management of appropriate and realistic goals hold considerable value in achieving patient-perceived satisfaction. PAO is successful in fulfilling expectations related to routine function, social activity, and psychological well-being.

Background: The utility of patient-reported outcome measures (PROMs) has been well established, but their interpretation relies on population-specific definitions of meaningful improvement. As such, the minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) thresholds have become prominent metrics in the orthopaedic evidence to ascribe clinical relevance to numeric PROM scores. Studies assessing outcomes of periacetabular osteotomy (PAO) relative to the MCID and PASS have previously evaluated patients against thresholds defined for hip arthroscopy for the treatment of femoroacetabular impingement or distribution-based MCID calculations. These scores may not accurately reflect the status or expectations of patients with a different symptom profile undergoing open hip preservation surgery. Questions/purposes: For patients treated with PAO, we sought to (1) define the MCID, SCB, and PASS threshold values for the mHHS (modified Harris hip score) and International Hip Outcome Tool 12 (iHOT-12) using anchor-based methods; (2) assess the validity of MCID and SCB estimates against minimal detectable change (MDC) values; and (3) determine the proportion of patients who achieved a clinically meaningful threshold. Methods: Between February 2011 and May 2023, a total of 690 patients underwent PAO for symptomatic acetabular dysplasia at one institution and were included in a longitudinally maintained hip preservation registry. The cohort used to define and validate MCID, SCB, and PASS threshold values consisted of those with a completed postoperative anchor questionnaire, which yielded 456 patients as potentially eligible. An additional 139 patients were excluded because of missing mHHS or iHOT-12 scores during the eligibility window (1 to 2 years postoperatively), leaving 70% (317 of 456) of patients to define and validate MCID, SCB, and PASS at a mean ± SD of 1.0 ± 0.3 years of follow-up. A minimum 1-year follow-up was chosen to reduce recall bias. The cohort for defining MCID, SCB, and PASS (94% [298 of 317] women, mean ± SD age at time of surgery 27 ± 8 years) included 21% (68 of 317) of patients with prior ipsilateral surgery. From those registry patients without complete anchor questionnaires, 37% (137 of 373) were identified with pre- and postoperative PROM scores at a mean ± SD of 1.0 ± 0.9 years of follow-up to form the sample for assessing the proportion of patients achieving a clinically meaningful threshold. The MCID, SCB, and PASS thresholds for the mHHS and iHOT-12 were calculated through an anchor-based approach, using area under the receiver operating curve to determine cut points that best identified positive responses, according to quality of life–based anchor questions. The MDC was calculated with confidence intervals (CIs) reflecting 80%, 90%, and 95% certainty to determine the smallest change in the PROM scores that can be considered above the level of measurement error. The validity of MCID estimates was assessed by confirming that they exceeded corresponding MDC values. The validity of SCB estimates were assessed by confirming that they exceeded corresponding MCID values. The proportion of patients achieving a clinically meaningful threshold was determined by calculating the percentage of patients who met the defined anchor-based scores. Results: The MCID, SCB, and PASS thresholds for the mHHS were 18, 23, and 71, respectively. The MCID, SCB, and PASS thresholds for the iHOT-12 were 26, 42, and 65, respectively. The MDC ranged from 8 to 12 for the mHHS and 10 to 16 for the iHOT-12. The MCID values for the mHHS and iHOT-12 exceeded corresponding values of the MDC at all CIs. The SCB thresholds exceeded all corresponding MDC and MCID values. Across the mHHS and iHOT-12, the proportion of patients who achieved an MCID at the first time point ranged from 60% to 73%, the proportion of patients who achieved the SCB ranged from 49% to 56%, and the proportion of patients who achieved the PASS threshold ranged from 55% to 79%. Among the cohort for defining MCID, SCB, and PASS, the proportion of patients achieving any MCID, SCB, or PASS was 79%, 66%, and 81%, respectively. Among the sample for assessing the proportion of patients achieving a clinically meaningful threshold, the proportion achieving any MCID, SCB, or PASS threshold was 74%, 58%, and 72%, respectively. Conclusion: We found that using a sample of patients undergoing PAO, the anchor-based values for the MCID and SCB were generally larger than previous distribution- and anchor-based scores that have been defined for hip preservation, whereas PASS threshold scores were similar. All MCID and SCB thresholds exceeded corresponding MDC values, confirming these scores to be valid estimates. These metrics provide more rigorous, procedure-specific definitions for the evaluation of treatment success and failure after PAO. As anchor-based metrics are defined based on patients’ perceptions, they should be used preferentially for postoperative assessment over distribution-based scores. Level of Evidence: Level III, therapeutic study.

Background: There are few data on the impact of periacetabular osteotomy (PAO) on sagittal spinopelvic alignment. Prior studies have attempted to delineate the relationship by performing measurements on AP radiographs and using mathematical models to determine changes in postoperative pelvic tilt. This information is clinically significant to a surgeon when evaluating acetabular/pelvic position intraoperatively and understanding spinopelvic alignment changes postoperatively; therefore, radiographic changes from PAO should be described in more detail. Questions/purposes: In this study, we asked: (1) Does the performance of PAO result in consistent changes in spinopelvic alignment, as measured on EOS radiographs? (2) Does this differ for unilateral versus bilateral PAOs? (3) Does this differ in the setting of a mobile spine versus an immobile spine? (4) Does this differ based on preoperative pelvic tilt? Methods: Mean preoperative and at least 1-year postoperative (15 ± 8 months from surgery, minimum 11 months, maximum 65 months) EOS hip-to-ankle standing and sitting radiographs for 55 patients in a prospectively collected registry who underwent PAO with a single surgeon from January 1, 2019, to January 11, 2022, were measured for pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, lateral center-edge angle, L1 pelvic angle, and pubic symphysis to the sacroiliac index. Normality was assessed and paired sample t-tests (normally distributed data) or Wilcoxon signed rank tests (not normally distributed data) were utilized to assess if any measurements changed from preoperative to postoperative. Patients were then divided based on whether they had unilateral or bilateral dysplasia and unilateral or bilateral surgery, and these subgroups were analyzed the same way as the entire cohort. Two more subgroups were then formed based on lumbar mobility, defined as a change in sitting-to-standing lumbar lordosis less or greater than 1 SD from the population mean preoperatively, and the subgroups were analyzed the same way as the entire cohort. Finally, two additional subgroups were formed, preoperative standing pelvic tilt less than 10° and more than 20°, and analyzed the same as the entire cohort. Results: For the entire cohort, the median (IQR) standing lateral-center edge angle increased 17°, from a median of 21° (10°) to a median of 38° (8° [95% confidence interval (CI) 16° to 20°; p < 0.001). The median sitting lateral center-edge angle increased 17°, from a median of 18° (8°) to a median of 35° (8° [95% CI 14° to 19°]; p < 0.001). Standing pelvic incidence increased from 50° ± 11° to 52° ± 12° (mean difference 2° [95% CI 1° to 3°]; p = 0.004), but there were no changes for other measured parameters. There were no changes in any of the spinopelvic parameters for patients with unilateral dysplasia receiving a unilateral PAO, but patients with bilateral dysplasia who underwent bilateral PAOs demonstrated an increase in pelvic incidence from 57° (14°) to 60° (16°) (95% CI 1° to 5°; p = 0.02) and a decrease in pubic symphysis to sacroiliac index from 84 mm (24 mm) to 77 mm (23 mm) (95% CI -7° to -2°; p = 0.007). Patients with mobile lumbar spines preoperatively did not exhibit any changes in sagittal spinopelvic alignment, but patients with immobile lumbar spines preoperatively experienced several changes after surgery. Patients with less than 10° of standing pelvic tilt demonstrated a median (IQR) 2° increase in pelvic incidence from median 43° (9°) to 45° (12° [95% CI 0.3° to 4°]; p = 0.03), but they did not experience any other changes in sagittal spinopelvic alignment parameters postoperatively. Patients with preoperative pelvic tilt more than 20° did not experience any change in sagittal spinopelvic parameters. Conclusion: PAO increases pelvic incidence, potentially because of anterior translation of the hip center. There were no changes in other spinopelvic parameters postoperatively except after bilateral PAO. Additionally, patients lacking spine mobility preoperatively, indicated by a minimal change in lumbar lordosis between standing and sitting positions, may experience several changes in spinopelvic alignment, including increased mobility of their spine after PAO. This may be because of decreased compensatory spine splinting after increasing acetabular coverage, but further research including patient-reported outcomes is warranted. Level of Evidence: Level III, therapeutic study.

Background: Over the past decade, hip arthroscopy has become more commonly used in the treatment of patients with femoroacetabular impingement (FAI) as well as those with many other intra-articular hip pathologies. As such, the indications for open surgical hip dislocation have narrowed to include complex intra-articular and extra-articular bony morphologies and revision hip preservation. Although surgical hip dislocation has been established as an effective approach, previous research using contemporary indications has been limited primarily to smaller cohorts with short-term follow-up. Furthermore, factors associated with reoperation, conversion arthroplasty, and not achieving clinical improvement remain ambiguous. Questions/purposes: At a minimum of 2 years of follow-up in patients treated for FAI with surgical hip dislocation, (1) how much did patient-reported outcome measures (PROMs) improve, and what percentage of patients achieved the minimum clinically important difference (MCID) and patient-acceptable symptom state (PASS)? (2) What was the survivorship free from reoperation of the hip for any reason? (3) What was the survivorship free from conversion to arthroplasty (THA or hip resurfacing)? Methods: Between February 2011 and April 2021, 211 patients were treated at one academic institution with surgical dislocation and osteoplasty of the femoral head-neck junction or greater trochanter for FAI. Of these, patients with concomitant diagnoses including Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, osteochondritis dissecans, a benign tumor, or another neurologic or metabolic disorder were excluded. This yielded 74% (156 of 211) of patients as potentially eligible. A further 12% (18 of 156) of patients without postoperative PROMs were excluded, and another 13% (21 of 156) were lost before the minimum study follow-up of 2 years, leaving 75% (117) for analysis at a median of 4.9 years (range 2 to 12 years) in this retrospective study. A total of 88% of the patients were women (103 of 117), and 40% (47 patients) underwent the procedure as a revision. All patients underwent surgical hip dislocation. Intraoperatively, 66% (77 of 117) of patients demonstrated cam impingement, and the remainder had either pincer impingement or combined cam and pincer; 82% (96 of 117) had some component of extra-articular impingement. To answer our first research question, we obtained PROM scores for the modified Harris hip score (mHHS) and international hip outcome tool 12 (iHOT-12) before surgery and at the most-recent follow-up from our longitudinally maintained institutional database, and we determined the percentage of patients who achieved the MCID or PASS. To answer our second research question, we calculated Kaplan-Meier survivorship free from any reoperation on the hip at 5.8 years (mean follow-up) after the index procedure. To answer our third research question, we calculated the Kaplan-Meier survivorship free from conversion to arthroplasty at 5.8 years. Using univariate logistic regression analysis, factors associated with meeting these defined endpoints were identified. Results: At a mean of 6 ± 3 years, the mHHS of patients treated with surgical hip dislocation for FAI who had not had previous surgery on the hip improved from 53 ± 15 to 85 ± 13 (mean difference 31 [95% confidence interval 27 to 36]; p < 0.01) and the mean iHOT-12 score improved from 25 ± 14 to 74 ± 24 (mean difference 49 [95% CI 42 to 56]; p < 0.01). At a mean of 5 ± 3 years, for patients with prior hip surgery, mHHS improved from 55 ± 13 to 79 ± 15 (mean difference 24 [95% CI 18 to 30]; p < 0.01) and iHOT-12 scores improved from 25 ± 16 to 66 ± 26 (mean difference 41 [95% CI 31 to 50]; p < 0.01). The proportion of patients who achieved the MCID for the mHHS was 87% (55 of 63) and 83% (33 of 40), while the proportion who achieved the PASS for the mHHS was 66% (46 of 70) and 51% (24 of 47) for primary and revision surgery, respectively. The proportion of patients who achieved the MCID for the iHOT-12 was 87% (53 of 61) and 83% (33 of 40), while the proportion who achieved the PASS for iHOT-12 was 68% (47 of 69) and 57% (26 of 46) for primary and revision surgery, respectively. Higher lateral center-edge angles (odds ratio 1.2 per 1° [95% CI 1.1 to 1.3]; p < 0.01), a lower acetabular version at 2:00 (OR 0.92 per 1° [95% CI 0.85 to 0.99]; p = 0.05), the absence of a labral tear (OR 0.21 [95% CI 0.06 to 0.79]; p = 0.02), a higher preoperative mHHS (OR 1.1 per 1 point [95% CI 1.02 to 1.2]; p < 0.01), and a higher preoperative iHOT-12 score (OR 1.1 per 1 point [95% CI 1.01 to 1.1]; p = 0.01) were associated with not achieving the MCID. In patients without a history of ipsilateral hip surgery, survivorship free from reoperation at 5.8 years after surgical hip dislocation was 90% (95% CI 82% to 98%). In the setting of prior ipsilateral hip surgery, survivorship free from reoperation at 5.8 years after surgical hip dislocation was 75% (95% CI 60% to 95%). No patients for whom surgical hip dislocation was their primary hip procedure underwent conversion to arthroplasty. Among the revision patient cohort, survivorship free from conversion to arthroplasty at 5.8 years after surgical hip dislocation was 97% (95% CI 91% to 100%). Conclusion: Surgical hip dislocation effectively improves hip pain and function with high survivorship (free of reoperation or conversion to arthroplasty) for complex intra-articular and extra-articular FAI that is deemed less suitable for arthroscopic treatment, but when the procedure is used in patients who have had prior hip surgery, they should be told that revision surgery is a realistic possibility. If insufficient acetabular coverage is anticipated, acetabular reorientation osteotomy should be considered. Future studies should evaluate long-term survivorship and PROMs in larger patient cohorts, as well as...

Background: The Pavlik harness has been used for approximately a century to treat developmental dysplasia of the hip (DDH). Femoral nerve palsy is a documented complication of Pavlik harness use, with an incidence ranging from 2.5% to 11.2%. Rare reports of brachial plexus palsy have also been documented. The primary purpose of the current study was to evaluate the incidence of various nerve palsies in patients undergoing Pavlik harness treatment for DDH. Secondary aims were to identify patient demographic or hip characteristics associated with nerve palsy. Methods: We performed a retrospective review of patients diagnosed with DDH and treated with a Pavlik harness from February 1, 2016, to April 1, 2023, at a single tertiary care orthopaedic hospital. Hip laterality, use of a subsequent rigid abduction orthosis, birth order, breech positioning, weight, and family history were collected. The median (and interquartile range [IQR]) or mean (and standard deviation [SD]) were reported for all continuous variables. Independent 2-sample t tests and Mann-Whitney U tests were conducted to identify associations between the variables collected at the initiation of Pavlik harness treatment and the occurrence of nerve palsy. Results: Three hundred and fifty-one patients (547 hips) were included. Twenty-two cases of femoral nerve palsy (4% of all treated hips), 1 case of inferior gluteal nerve palsy (0.18%), and 2 cases of brachial plexus palsy (0.37%) were diagnosed. Patients with nerve palsy had more severe DDH as measured by the Graf classification (p < 0.001) and more severe DDH as measured on physical examination via the Barlow and Ortolani maneuvers (p = 0.003). Conclusions: Nerve palsies were associated with more severe DDH at the initiation of Pavlik harness use. Upper and lower-extremity neurological status should be scrutinized at initiation and throughout treatment to assess for nerve palsies. The potential for femoral, gluteal, and brachial plexus palsies should be included in the discussion of risks at the beginning of treatment. Families may be reassured that nerve palsies associated with Pavlik harness can be expected to resolve with a short break from treatment. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.