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Risk factors for avascular necrosis after closed reduction for developmental dysplasia of the hip

PURPOSE: The purpose of this study was to identify and evaluate risk factors of avascular necrosis (AVN) after closed treatment for developmental dysplasia of the hip (DDH). METHODS: A retrospective review of children diagnosed with DDH at a tertiary-care children’s hospital between 1986 and 2009 wa...

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Detalles Bibliográficos
Autores principales: Schur, Mathew D., Lee, Christopher, Arkader, Alexandre, Catalano, Anthony, Choi, Paul D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909658/
https://www.ncbi.nlm.nih.gov/pubmed/27177477
http://dx.doi.org/10.1007/s11832-016-0743-7
Descripción
Sumario:PURPOSE: The purpose of this study was to identify and evaluate risk factors of avascular necrosis (AVN) after closed treatment for developmental dysplasia of the hip (DDH). METHODS: A retrospective review of children diagnosed with DDH at a tertiary-care children’s hospital between 1986 and 2009 was performed. The presence of AVN was assessed according to Salter’s classification system. RESULTS: Eighty-two affected hips in 70 children with an average age of 10 months at closed reduction (range 1–31 months) and 5 years (range 2–19 years) of follow-up met the inclusion criteria. Twenty-nine (of 82, 35 %) affected hips developed AVN. The use of pre-reduction traction (p = 0.019) increased the risk of AVN, while preoperative Pavlik harness or brace trial (p = 0.28), presence of ossific nucleus at the time of closed reduction (p = 0.16), and adductor tenotomy (p = 0.37) were not significant factors. Laterality (right vs. left) was also not a significant risk factor (p = 0.75), but patients who underwent closed reduction for bilateral DDH were less likely to develop AVN (p = 0.027). Overall, the degree of abduction did not affect the rate of AVN (p = 0.87). However, in patients treated with closed reduction younger than 6 months of age, the rate of AVN was increased with abduction ≥50° (9/15, 60 %) compared to abduction <50° (0/8, 0 %) (p = 0.007). Patients who developed AVN were more likely to require subsequent surgery (p = 0.034) and more likely to report a fair/poor clinical outcome (p = 0.049). CONCLUSIONS: The risk of AVN (35 %) following closed reduction and spica casting for DDH is high. The degree of abduction in spica casts appears to be a risk factor in patients ≤6 months old. The authors recommend that abduction in spica casts should be limited to <50° in children younger than 6 months of age. LEVEL OF EVIDENCE: IV.