Open reduction through a medial approach for congenital dislocation of the hip. A critical review of the Ludloff approach in sixty-six hips.

Mankey, Martin G.; Arntz, G T; Staheli, Lynn T.

doi:10.2106/00004623-199309000-00008

Cited by 89 publications

(71 citation statements)

References 19 publications

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“…Although some classify it as a form of Grade I osteonecrosis [9,49,81], others do not consider it osteonecrosis [13,20,30,41,56,63,72,85,96]. Because of such variability, osteonecrosis was defined as radiographic changes of Grade II or greater in the meta-analysis.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…Sixteen studies [1,4,5,11,14,27,49,53,56,61,62,65,69,88,94,95] statistically analyzed the relationship between age at reduction and the occurrence of osteonecrosis. The analyses of five studies [56,62,69,94,95] were based partly on data that did not reflect our definition of index reduction.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The analyses of five studies [56,62,69,94,95] were based partly on data that did not reflect our definition of index reduction. Significance levels were not published in three studies [14,27,61] and were reported as 0.05 in all other reviewed studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The same is true for DDH treatment by open reduction. Although a correlation between increased age at reduction and osteonecrosis has been reported [49,55,56,62,65], others have found no such association [4,5,11,27,95].…”

Section: Introductionmentioning

confidence: 96%

“…Critics of the medial techniques cite an increased risk of osteonecrosis with reported rates reaching 67% [43]. Although such risk often is attributed to accidental damage of the medial femoral circumflex artery, it is unclear whether injury to this vessel causes osteonecrosis [28,56]. Conclusions regarding the effectiveness of anterior versus medial operative approaches have been hindered by a lack of studies that directly compare osteonecrosis rates.…”

Section: Introductionmentioning

confidence: 99%

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Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis

Novais

Hill

Carry

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Osteonecrosis of the femoral head is a major complication that negatively impacts the clinical and radiographic long-term outcome after treatment of developmental hip dysplasia (DDH). There are conflicting results in the literature whether age at the time of closed or open reduction and a specific surgical approach are associated with osteonecrosis. Better understanding of the impact of age at reduction and surgical approach is important to reduce the risk of osteonecrosis in patients with DDH. Questions/purposes We aimed to evaluate the association between occurrence of osteonecrosis and (1) age at closed reduction; (2) age at open reduction; and (3) medial versus anterior operative approaches.Methods A systematic review identified studies reporting osteonecrosis occurrence after treatment of DDH and at least 2 years of followup. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Methodologic quality was assessed using the methodologic index for nonrandomized studies. Generalized logistic models were used to estimate pooled odds ratios (ORs) in the meta-analysis. Sixty-six studies were included in the systematic review and 24 in the meta-analysis. Data on 481 hips treated by closed reduction and 584 hips treated by open reduction were available to evaluate the association between osteonecrosis and age. The association between osteonecrosis and operative approach was assessed using data on 364 hips treated by medial open reduction and 220 hips treated by anterior open reduction. Results Age at reduction ([ 12 months versus B 12 months) was not associated with osteonecrosis after closed reduction (OR, 1.1; 95% confidence interval [CI], 0.4-3.2; p = 0.9) or open reduction (OR, 1.1; 95% CI, 0.7-1.9; p = 0.66). The overall, adjusted incidence of osteonecrosis (C Grade II) was 8.0% (95% CI, 2.8%-20.6%) among patients treated with closed reduction at or before 12 months of age and 8.4% (95% CI, 3.0%-21.

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