The incidence of avascular necrosis following a cohort of treated developmental dysplasia of the hip in a single tertiary centre

Hussain, Rahim; Rad, Darius; Watkins, William J.; Carpenter, Clare

doi:10.1302/1863-2548.15.200246

Cited by 11 publications

(11 citation statements)

References 41 publications

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“…This can only be achieved with a concentrically reduced hip. In a logistic regression analysis where they analyzed the effect of age at initial treatment on the development of AVN, they reported that their model predicted 83.9% accurately and the probability of AVN development was higher in those with advanced age at initial treatment (13). Achieving successful results gets harder as patients get older (4,8,14).…”

Section: Discussionmentioning

confidence: 99%

How Does Initial Surgery Age Affect the Radiological Results of Single-Stage Open Reduction, Femoral Shortening, and Salter’s Osteotomy in Patients Over the Age of Four With Developmental Hip Dysplasia ?

Bahar¹,

YAĞMURLU²

2023

Kocatepe Tıp Dergisi

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OBJECTIVE: One of the most controversial issues in pediatric orthopedics is Developmental dysplasia of the hip (DDH). The timing of diagnosis and treatment are is the main goal to treat this condition successfully. Neglected cases that may remain undiagnosed until advancing age are still seen especially in developing countries. Delayed diagnosis and treatment with advancing age leads to more extensive surgery and cause low satisfactory rates. The aim of this study is to evaluate the effect of patients’ age on the results of single-stage treatment of Developmental Dysplasia of the Hip.MATERIAL AND METHODS: 23 patients (34 hips) treated in our hospital between 2004 and 2010 were included in the study. Single-stage treatment including open reduction, femoral shortening, and Salter’s innominate osteotomy was applied to patients whose mean age of surgery was 7.5 years. Radiological results were evaluated in terms of improvement in the acetabular index, in the acetabular angle and according to Severin’s classification, and Bucholz and Ogden’s avascular necrosis (AVN) classification at the final follow-up.RESULTS: The average follow-up period was 60 (range: 24 - 84) months. While the acetabular index was 39.7°±1.4° (range: 25°- 52°) preoperatively, it was measured as 21.8°±1.8° postoperatively. The mean amount of improvement in the acetabular angle was 17.9°±0.8°. According to Bucholz and Ogden’s classification, one patient (2.9%) had Type 1 AVN and one patient (2.9%) had Type 3 AVN. Radiologically, the success rate (85.7%) was significantly higher in children aged 8 years and younger (p = 0.008).CONCLUSIONS: According to the improvement in the acetabular index and Severin's radiological classification, successful results are obtained after a single-step treatment of DDH, which is treated in the 4-8 age range. However, the radiological results of children older than 8 years are worse than those under 8 years old.

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Section: Discussionmentioning

confidence: 99%

How Does Initial Surgery Age Affect the Radiological Results of Single-Stage Open Reduction, Femoral Shortening, and Salter’s Osteotomy in Patients Over the Age of Four With Developmental Hip Dysplasia ?

Bahar¹,

YAĞMURLU²

2023

Kocatepe Tıp Dergisi

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“…For example, Hurley et al performed logistic regression on 250 hips treated with closed reduction only and found a significantly higher incidence of additional surgical intervention in patients who undergo treatment after 12 months of age [14]. Similarly, a retrospective study by Hussain et al reported a higher incidence of AVN in children who were diagnosed with DDH at an older age [28].…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, a retrospective study by Hussain et al . reported a higher incidence of AVN in children who were diagnosed with DDH at an older age [28].…”

Section: Discussionmentioning

confidence: 99%

Severity of hip dysplasia as the major factor affecting outcome of closed reduction in children with hip dysplasia

Cummings,

Oladeji,

Rosenfeld

et al. 2023

Journal of Pediatric Orthopaedics B

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The objective of this study was to analyze a multicenter cohort of children with developmental dysplasia of the hip (DDH) who underwent treatment with closed reduction. We sought to report the effects that severity of hip dysplasia and age have on the development of femoral head avascular necrosis (AVN) and the need for additional procedures. All patients with DDH and minimum 2 years of follow-up who underwent closed reduction were identified. The following variables were recorded: sex, laterality of hip involvement, age, acetabular index (AI), and International Hip Dysplasia Institute (IHDI) grade. The effects of patient age and pre-procedure IHDI grade on the rate of AVN and need for additional procedures after the closed reduction were analyzed using an alpha of 0.05. Seventy-eight total hips were included in the final analysis. The average patient age was 12 months. AVN of the femoral head was reported in 24 hips (30.8%) and 32 hips (41.0%) required additional surgery. Higher pre-op IHDI grade was associated with higher risk of developing Bucholz-Ogden grades II-IV AVN of the femoral head (P = 0.025) and requiring additional surgery (P= 0.033) regardless of patient age. There were no statistically significant differences for the effect of age on the measured outcomes (P > 0.05). These findings suggest that severity of dislocation (IHDI grade) is a significant risk factor for the development of AVN and need for additional procedure.

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“…The Smith Petersen approach is considered a safe approach in arthrogryposis-related dislocated hips even if done prior to the age of 12 months [ 10 ]. The AVN rate may reach 23% among patients who undergo open reduction of a dislocated hip [ 11 ]. Hip dislocation in arthrogryposis patients requires an extensive surgical approach due to the nature of the extensive fibrosis surrounding the capsule, which makes the reduction difficult and increases the risk of complications, including redislocation [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Open Reduction at 15 Months of Left Hip Dislocation in a Male Infant Diagnosed with Arthrogryposis

et al. 2022

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Patient: Male, 4-week-old Final Diagnosis: Arthrogryposis Symptoms: Limited hip motion Medication:— Clinical Procedure: Open reduction of hip and femoral shortening Specialty: Orthopedics and Traumatology Objective: Unusual or unexpected effect of treatment Background: Arthrogryposis is a congenital condition of multiple contractures of joints associated with hip dislocation. The outcome of open reduction of hip dislocation in arthrogryposis patients is debatable. Open reduction of arthrogryposis is challenging for shallow acetabulum and extensive adhesions and fibrosis. For this reason, a careful extensive release must be carried out to achieve the open reduction of the hip in arthrogryposis patients. The literature lacks surgical recommendations for open reduction of the hip in arthrogryposis patients and how to deal with cases of the extruded bone segment during open reduction. Case Report: The patient presented in the first few weeks of life with bilateral clubfoot and left hip dislocation. Clinical diagnosis of arthrogryposis was made after referral to a genetics specialist. The hip was clinically irreducible. The patient underwent open reduction and femoral shortening using the Smith Peterson approach at the age of 15 months, with accidental extrusion of the proximal femur, which was retained immediately. The clinical outcome showed a painless, good range of motion. Radiographically, features of avascular necrosis and healed osteotomy site were evident. Conclusions: A difficult hip reduction was expected in this arthrogryposis patient, which required careful dissection of surrounding fibrosis and appropriate femoral shortening. Careful dissection should be carried out during open reduction to avoid jeopardization of femoral head vascularity or even complete devitalization of the proximal femur.

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The incidence of avascular necrosis following a cohort of treated developmental dysplasia of the hip in a single tertiary centre

Cited by 11 publications

References 41 publications

How Does Initial Surgery Age Affect the Radiological Results of Single-Stage Open Reduction, Femoral Shortening, and Salter’s Osteotomy in Patients Over the Age of Four With Developmental Hip Dysplasia ?

How Does Initial Surgery Age Affect the Radiological Results of Single-Stage Open Reduction, Femoral Shortening, and Salter’s Osteotomy in Patients Over the Age of Four With Developmental Hip Dysplasia ?

Severity of hip dysplasia as the major factor affecting outcome of closed reduction in children with hip dysplasia

Open Reduction at 15 Months of Left Hip Dislocation in a Male Infant Diagnosed with Arthrogryposis

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