Avascular necrosis under different treatment in children with developmental dysplasia of the hip: a network meta-analysis

Qiu, Meiling; Chen, Meiyi; Sun, Hao; Deng, Li; Cai, Zhiqing; Zhang, Wenhui; Xu, Jie; Ma, Ruofan

doi:10.1097/bpb.0000000000000932

Cited by 5 publications

(6 citation statements)

References 46 publications

(65 reference statements)

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“…The condition might result from traumatic or non-traumatic factors and eventually leads to the collapse of the femoral head [ 1 , 23 , 24 ]. Furthermore, AVN of the femoral head is linked to pathological synovial reaction, hypertrophy, effusion, and an increase in intra-articular pressure [ 2 , 4 , 25 – 28 ]. To understand the correlation between intra-articular pressure of the hip joint and blood flow to the femoral head in animal models, a microsphere of radioactively-labeled red cells was used.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of arthroscopic synovectomy and core decompression through multiple small bone holes for early-stage avascular necrosis of the femoral head

Luo

et al. 2023

Arthroplasty

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Objective This study described a minimally invasive approach for the management of early-stage avascular necrosis of the femoral head, which integrated arthroscopic intra-articular decompression and core decompression by drilling multiple small holes. Method A total of 126 patients with 185 hip avascular necrosis were included between March 2005 and January 2008, and the hips were classified, based on the Association Research Circulation Osseous staging system, into stage I (n = 43), stage II (n = 114), and stage III (n = 28). Arthroscopic intra-articular inspection and debridement, along with drilling of multiple small holes for core decompression, were performed. The Modified Harris hip score system and radiographs were used to assess the pre- and post-surgery outcomes. Results One hundred and three patients (involving 153 hips) were followed up successfully for an average of 10.7 ± 3.4 years (range: 9–12 years). After surgery, the overall survival rate was 51.6% (79 hips), and the clinical survival rates were 79%, 72%, 52%, 32%, and 10% for patients with stage I, IIa, IIb, IIc, and III, respectively. The outcomes of patients with Association Research Circulation Osseous Stages I or IIA were better than those of other stages, while hips with a large necrotic area had poor results. This approach preserved the original biomechanical strength of the femoral head after core decompression and eliminated arthritis factors in the hip joint. Conclusion The core decompression with multiple small-size holes is an effective method for treating early-stage avascular necrosis of the femoral head, particularly in those with pathological changes in the hip joint. Level of evidence Therapeutic study, Level IV.

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Section: Discussionmentioning

confidence: 99%

Long-term outcomes of arthroscopic synovectomy and core decompression through multiple small bone holes for early-stage avascular necrosis of the femoral head

Luo

et al. 2023

Arthroplasty

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“…We demonstrated via multivariate analysis that closed reduction and open reduction had comparable effects on the incidence of osteonecrosis. For children under 3 years old with DDH, open reduction alone is most likely to be the treatment with the highest incidence rate of ANFH, followed by open reduction combined with osteotomy, and closed reduction is the least likely to cause ANFH ( 14 ), suggesting that the association of DDH classification and preoperative traction with the risk of ANFH may vary in DDH patients with closed and open reduction. Then we explored this potential variation across closed and open reduction populations, and demonstrated that for children undergoing open reduction, DDH classification was positively associated with the risk of postoperative ANFH, and those with preoperative traction had a lower risk of postoperative ANFH than those without.…”

Section: Discussionmentioning

confidence: 99%

“…As indicated above with small sample sizes, the associations between the identified risk factors and ANFH may vary in DDH patients with different ages. Besides, sex and surgical method (closed and open reduction), relating to the risk of ANFH ( 8 , 14 ), should also be considered when evaluating the risk factors of ANFH, which lacks research at present.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for postoperative avascular necrosis of the femoral head in children with developmental dysplasia of the hip

Yong

Lou

et al. 2023

Front. Pediatr.

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AimTo investigate factors associated with postoperative avascular necrosis of the femoral head (ANFH) in developmental dysplasia of the hip (DDH) patients, and if or how the associations varied among different subpopulations of age, sex and surgical method.MethodsPatients with DDH were enrolled between October 31, 2016 and July 15, 2020 in this retrospective cohort study. The average follow-up time was 21.42 ± 10.02 months. The outcome was postoperative ANFH. The main study variables were the DDH classification, Tonnis grade, International Hip Dysplasia Institute (IHDI) classification, and preoperative traction. Multivariate logistic regression was employed to assess the associations between main study variables and postoperative ANFH. Subgroup analysis was carried out based on age at reduction, sex and surgical method. Odds ratio (ORs) and 95% confidence intervals (CIs) were calculated.ResultsA total of 427 children with DDH were included, with 92 (21.55%) in the ANFH group, and 335 (78.45%) in the non-ANFH group. DDH classification was positively correlated with the risk of postoperative ANFH (OR = 4.14, 95% CI, 1.08–15.77, P = 0.038). Children with preoperative traction had a significantly decreased risk of postoperative ANFH in contrast to those without preoperative traction (OR = 0.37, 95% CI, 0.22–0.61, P < 0.001). Children aged 1–3 years who received preoperative traction has a significantly reduced risk of postoperative ANFH than those who did not receive preoperative traction (OR = 0.28, 95% CI, 0.15–0.51, P < 0.001). For children aged >3 years, positive association was found between DDH classification and the risk of postoperative ANFH (OR = 3.75, 95% CI, 1.51–9.31, P = 0.004). Girls with a more severe DDH type had a significantly higher risk of postoperative ANFH (OR = 3.80, 95% CI, 1.80–8.02, P < 0.001). Receiving preoperative traction was associated with a significantly decreased risk of postoperative ANFH in girls (OR = 0.37, 95% CI, 0.22–0.61, P < 0.001). For children undergoing open reduction, DDH classification was positively associated with the risk of postoperative ANFH (OR = 3.01, 95% CI, 1.65–5.50, P < 0.001), and those with preoperative traction had a lower risk of postoperative ANFH compared with those without preoperative traction (OR = 0.35, 95% CI, 0.20–0.61, P < 0.001).ConclusionDDH classification and preoperative traction were associated with the risk of postoperative ANFH, and these associations varied across DDH patients with different ages, sexes and surgical methods.

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“…[5][6][7] Additional data also suggest that patients who undergo open reduction alone are at increased risk for proximal femoral growth disturbance (PFGD) (often termed avascular necrosis) and reoperation. 5,8 Nevertheless, assessment of preoperative and intraoperative risk factors for complications after open reductions has been limited to smaller, single-center cohorts.…”

mentioning

confidence: 99%

“…Multiple studies have demonstrated that clinical outcomes after open hip reduction are better for younger patients and those treated with concomitant pelvic osteotomy 5–7. Additional data also suggest that patients who undergo open reduction alone are at increased risk for proximal femoral growth disturbance (PFGD) (often termed avascular necrosis) and reoperation 5,8. Nevertheless, assessment of preoperative and intraoperative risk factors for complications after open reductions has been limited to smaller, single-center cohorts.…”

mentioning

confidence: 99%

A Prospective, Multicenter Study of Developmental Dysplasia of the Hip: What Can Patients Expect After Open Reduction?

Kiani

Gornitzky

Matheney

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Although there are several predominantly single-center case series in the literature, relatively little prospectively collected data exist regarding the outcomes of open hip reduction (OR) for infantile developmental dysplasia of the hip (DDH). The purpose of this prospective, multi-center study was to determine the outcomes after OR in a diverse patient population. Methods: The prospectively collected database of an international multicenter study group was queried for all patients treated with OR for DDH. Minimum follow-up was 1 year. Proximal femoral growth disturbance (PFGD) was defined by consensus review using Salter’s criteria. Persistent acetabular dysplasia was defined as an acetabular index >90th percentile for age. Statistical analyses were performed to compare preoperative and operative characteristics that predicted re-dislocation, PFGD, and residual acetabular dysplasia. Results: A cohort of 232 hips (195 patients) was identified; median age at OR was 19 months (interquartile range 13 to 28) and median follow-up length was 21 months (interquartile range 16 to 32). Re-dislocation occurred in 7% of hips (n=16/228). The majority (81%; n=13/16) occurred in the first year after initial OR. Excluding patients with repeat dislocation, 94.5% of hips were IHDI 1 at most recent follow-up. On the basis of strict radiographic review, some degree of PFGD was present in 44% of hips (n=101/230) at most recent follow-up. Seventy-eight hips (55%) demonstrated residual dysplasia compared with established normative data. Hips that had a pelvic osteotomy at index surgery had about half the rate of residual dysplasia (39%; n=32/82) versus those without a pelvic osteotomy with at least 2 years follow-up (78%; n=46/59). Conclusions: In the largest prospective, multicenter study to date, OR for infantile DDH was associated with a 7% risk of re-dislocation, 44% risk of PFGD, and 55% risk of residual acetabular dysplasia at short term follow-up. The incidence of these adverse outcomes is higher than previous reports. Patients treated with concomitant pelvic osteotomy had lower rates of residual dysplasia. These prospectively collected, multicenter data provide better generalizable information to improve family education and appropriately set expectations. Level of Evidence: Level II, prospective comparative study.

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Avascular necrosis under different treatment in children with developmental dysplasia of the hip: a network meta-analysis

Cited by 5 publications

References 46 publications

Long-term outcomes of arthroscopic synovectomy and core decompression through multiple small bone holes for early-stage avascular necrosis of the femoral head

Long-term outcomes of arthroscopic synovectomy and core decompression through multiple small bone holes for early-stage avascular necrosis of the femoral head

Risk factors for postoperative avascular necrosis of the femoral head in children with developmental dysplasia of the hip

A Prospective, Multicenter Study of Developmental Dysplasia of the Hip: What Can Patients Expect After Open Reduction?

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