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Risk Factors for Avascular Necrosis After Closed Reduction for Developmental Dysplasia of the Hip

Avascular necrosis (AVN) is a major complication after closed reduction for developmental dysplasia of the hip. The factors that predispose to AVN remain controversial. The purpose of this study was to analyze the risk factors, especially patient factors, such as age at reduction, grade of dislocati...

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Autores principales: Bian, Zhen, Guo, Yuan, Lyu, XueMin, Zhu, ZhenHua, Yang, Zheng, Wang, YuKun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Hip
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9470038/
https://www.ncbi.nlm.nih.gov/pubmed/35948526
http://dx.doi.org/10.1097/BPO.0000000000002228
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author Bian, Zhen
Guo, Yuan
Lyu, XueMin
Zhu, ZhenHua
Yang, Zheng
Wang, YuKun
author_facet Bian, Zhen
Guo, Yuan
Lyu, XueMin
Zhu, ZhenHua
Yang, Zheng
Wang, YuKun
author_sort Bian, Zhen
collection PubMed
description Avascular necrosis (AVN) is a major complication after closed reduction for developmental dysplasia of the hip. The factors that predispose to AVN remain controversial. The purpose of this study was to analyze the risk factors, especially patient factors, such as age at reduction, grade of dislocation, and ossific nucleus development, related to AVN. MATERIALS AND METHODS: We retrospectively reviewed children with dysplasia of the hip treated by closed reduction between 1997 and 2006. AVN was evaluated using Salter criteria and Kalamchi and MacEwen classification. Related factors were analyzed. RESULTS: One hundred and eight children (140 hips) with an average age of 16.6 months at closed reduction (range: 6-24 mo) were included in the study. For an average duration of 10.1 years (range 7–16 y) of follow-up, 44 hips (31.4%) developed AVN. Grade II or higher AVN occurred in 14 hips (10%). The incidence of AVN increased with the grade of dislocation (P=0.022) and underdevelopment of the ossific nucleus (P<0.001). Underdevelopment of the ossific nucleus was also found to be positively correlated with the dislocation grade (P=0.047). The age at the time of reduction, sex, and side were not significant factors. Children who underwent secondary operation were all older than 1 year at reduction. CONCLUSIONS: High-grade dislocation correlates with the underdevelopment of the ossific nucleus. Patients with these 2 characteristics are predisposed to AVN. As underdevelopment of the ossific nucleus occurred regardless of age, it is not advisable to delay reduction because it does not alter the AVN rate, and instead, it increases the secondary operation rate. LEVEL OF EVIDENCE: Level IV case series.
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spelling pubmed-94700382022-09-21 Risk Factors for Avascular Necrosis After Closed Reduction for Developmental Dysplasia of the Hip Bian, Zhen Guo, Yuan Lyu, XueMin Zhu, ZhenHua Yang, Zheng Wang, YuKun J Pediatr Orthop Hip Avascular necrosis (AVN) is a major complication after closed reduction for developmental dysplasia of the hip. The factors that predispose to AVN remain controversial. The purpose of this study was to analyze the risk factors, especially patient factors, such as age at reduction, grade of dislocation, and ossific nucleus development, related to AVN. MATERIALS AND METHODS: We retrospectively reviewed children with dysplasia of the hip treated by closed reduction between 1997 and 2006. AVN was evaluated using Salter criteria and Kalamchi and MacEwen classification. Related factors were analyzed. RESULTS: One hundred and eight children (140 hips) with an average age of 16.6 months at closed reduction (range: 6-24 mo) were included in the study. For an average duration of 10.1 years (range 7–16 y) of follow-up, 44 hips (31.4%) developed AVN. Grade II or higher AVN occurred in 14 hips (10%). The incidence of AVN increased with the grade of dislocation (P=0.022) and underdevelopment of the ossific nucleus (P<0.001). Underdevelopment of the ossific nucleus was also found to be positively correlated with the dislocation grade (P=0.047). The age at the time of reduction, sex, and side were not significant factors. Children who underwent secondary operation were all older than 1 year at reduction. CONCLUSIONS: High-grade dislocation correlates with the underdevelopment of the ossific nucleus. Patients with these 2 characteristics are predisposed to AVN. As underdevelopment of the ossific nucleus occurred regardless of age, it is not advisable to delay reduction because it does not alter the AVN rate, and instead, it increases the secondary operation rate. LEVEL OF EVIDENCE: Level IV case series. Lippincott Williams & Wilkins 2022-10 2022-08-11 /pmc/articles/PMC9470038/ /pubmed/35948526 http://dx.doi.org/10.1097/BPO.0000000000002228 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Hip
Bian, Zhen
Guo, Yuan
Lyu, XueMin
Zhu, ZhenHua
Yang, Zheng
Wang, YuKun
Risk Factors for Avascular Necrosis After Closed Reduction for Developmental Dysplasia of the Hip
title Risk Factors for Avascular Necrosis After Closed Reduction for Developmental Dysplasia of the Hip
title_full Risk Factors for Avascular Necrosis After Closed Reduction for Developmental Dysplasia of the Hip
title_fullStr Risk Factors for Avascular Necrosis After Closed Reduction for Developmental Dysplasia of the Hip
title_full_unstemmed Risk Factors for Avascular Necrosis After Closed Reduction for Developmental Dysplasia of the Hip
title_short Risk Factors for Avascular Necrosis After Closed Reduction for Developmental Dysplasia of the Hip
title_sort risk factors for avascular necrosis after closed reduction for developmental dysplasia of the hip
topic Hip
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9470038/
https://www.ncbi.nlm.nih.gov/pubmed/35948526
http://dx.doi.org/10.1097/BPO.0000000000002228
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