Risk Factors for Avascular Necrosis After Closed Reduction for Developmental Dysplasia of the Hip.
J Pediatr Orthop
; 42(9): 467-473, 2022 Oct 01.
Article
em En
| MEDLINE
| ID: mdl-35948526
ABSTRACT
BACKGROUND:
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 ANDMETHODS:
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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Necrose da Cabeça do Fêmur
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Displasia do Desenvolvimento do Quadril
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Luxação Congênita de Quadril
Tipo de estudo:
Etiology_studies
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Observational_studies
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Risk_factors_studies
Limite:
Child
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Humans
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Infant
Idioma:
En
Revista:
J Pediatr Orthop
Ano de publicação:
2022
Tipo de documento:
Article
País de publicação:
EEUU
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ESTADOS UNIDOS
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ESTADOS UNIDOS DA AMERICA
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EUA
/
UNITED STATES
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UNITED STATES OF AMERICA
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US
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USA