http://www.bjj.boneandjoint.org.uk/content/96-B/2/279.abstract

The incidence of avascular necrosis and the radiographic outcome following medial open reduction in children with developmental dysplasia of the hip

A systematic review

1. C. S. Bradley, MSc, BScPT, Physiotherapist, Department of Rehabilitation Services1;
2. A. Howard, MD, MSc, FRCS(C), Associate Professor2;
3. U. G. Narayanan, MBBS, MSc, FRCS(C), Assistant Professor2;
4. J. H. Wedge, MD, FRCS(C), Professor2; and
5. S. P. Kelley, FRCS(Tr & Orth), Assistant Professor2

+ Author Affiliations

1. 1Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
2. 2Hospital for Sick Children, Department of Orthopaedic Surgery, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.

1. Correspondence should be sent to Mr R. O. E. Gardner; e-mail:richardgardner@doctors.org.uk

Abstract

The incidence of clinically significant avascular necrosis (AVN) following medial open reduction of the dislocated hip in children with developmental dysplasia of the hip (DDH) remains unknown. We performed a systematic review of the literature to identify all clinical studies reporting the results of medial open reduction surgery. A total of 14 papers reporting 734 hips met the inclusion criteria. The mean follow-up was 10.9 years (2 to 28). The rate of clinically significant AVN (types 2 to 4) was 20% (149/734). From these papers 221 hips in 174 children had sufficient information to permit more detailed analysis. The rate of AVN increased with the length of follow-up to 24% at skeletal maturity, with type 2 AVN predominating in hips after five years’ follow-up. The presence of AVN resulted in a higher incidence of an unsatisfactory outcome at skeletal maturity (55% vs 20% in hips with no AVN; p < 0.001). A higher rate of AVN was identified when surgery was performed in children aged < 12 months, and when hips were immobilised in ≥ 60°of abduction post-operatively. Multivariate analysis showed that younger age at operation, need for further surgery and post-operative hip abduction of ≥ 60° increased the risk of the development of clinically significant AVN.

Cite this article: Bone Joint J 2014;96-B:279–86.

Footnotes

• This study was initiated and is supported by the International Hip Dysplasia Institute. The authors thank E. Uleryk for her assistance in performing the literature search.
  No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
  This article was primary edited by P. Baird and first proof edited by J. Scott.
• Supplementary material. Tables detailing the search strategy and the studies and data available for patient level analysis are available with the electronic version of this article.

• Received July 22, 2013.
• Accepted October 1, 2013.

• ©2014 The British Editorial Society of Bone & Joint Surgery