Developmental dysplasia of the hip: can contrast-enhanced MRI predict the development of avascular necrosis following surgery?

Nguyen, Jie C.; Back, Susan J.; Barrera, Christian A.; Patel, Malika; Nguyen, Michael K.; Hong, Shijie; Sankar, Wudbhav N.

doi:10.1007/s00256-020-03572-z

Cited by 7 publications

(11 citation statements)

References 29 publications

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“…Benefit from MRI, it’s convenient for clinicians, regardless of experience level, subspecialty, or geographic origin, to assess the quality of hip reduction and predict surgical reduction of avascular necrosis (AVN). Magnetic resonance imaging provides a more reliable interpretation than standard X-rays and reduces radiation exposure [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of irreducible aspects in developmental hip dysplasia by magnetic resonance imaging

et al. 2020

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Background The developmental dysplasia of the hip (DDH) can cause a wide range of pathological changes, and often requires surgical treatment. Preoperative evaluation is very important for DDH. We aimed to assess the diagnostic capability of magnetic resonance imaging (MRI) for irreducible aspects preventing hip reduction in DDH. Methods A total of 39 pediatric patients who received DDH evaluation in pediatric orthopedics from January 2015 to December 2019 were included. The samples included 4 cases of bilateral DDH and 35 cases of unilateral DDH, a total of 43 hip joint samples. All patients underwent surgical treatment, pathological examination and MRI of hip joint. Results With pathological results or intraoperative findings as the gold standard, the sensitivity and specificity of MRI were 90.3% and 83.3% for the affected labrum, 92% and 83.3% for thickening of the round ligament, 90.0% and 91.3% for atrophy of the iliopsoas muscle, and 100% and 100% for fibrofatty pulvinar tissue and joint effusion, respectively. Conclutions The MRI showed an extraordinary capability of detecting these irreducible factors and helped surgeon choose the appropriate treatment strategies.

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Section: Introductionmentioning

confidence: 99%

Assessment of irreducible aspects in developmental hip dysplasia by magnetic resonance imaging

et al. 2020

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“…Haruno et al [17] suggested cut-off value of epiphyseal enhancement, which was less than 80%, exhibited a sensitivity of 87.5% and specificity of 88.25% in the diagnosis of epiphyseal osteonecrosis after closed reduction of DDH using contrast-enhanced spica MRI. However, Nguyen et al [25] reported that neither of enhancement pattern nor percent enhancement predicted AVN on postoperative MRI. Considering transient ischemia of the proximal femoral epiphysis induced by hip abduction, we subjectively estimated global decreased enhancement when the nonenhancing area of the proximal femoral epiphysis was larger than 3/4 of the proximal femoral epiphysis area with loss of normal striated or speckled enhancement.…”

Section: Discussionmentioning

confidence: 99%

MRI risk factors for development of avascular necrosis after closed reduction of developmental dysplasia of the hip: Predictive value of contrast-enhanced MRI

et al. 2021

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Purpose The purpose of this study was to identify imaging risk factors on contrast-enhanced hip MRI after closed reduction of developmental dysplasia of the hip (DDH) that could predict future development of avascular necrosis (AVN) of the femoral head. Materials and methods Fifty-eight infants (F: M = 53: 5, aged 3–18 months) who underwent immediate postoperative contrast-enhanced hip MRI after closed reduction of DDH were included in this study. Quality of reduction (concentric vs eccentric reduction with or without obstacles), abduction angle of the hip, presence of ossific nucleus, and pattern of contrast enhancement of the femoral head were retrospectively evaluated on MRI. Interobserver agreement of contrast enhancement pattern on MRI were evaluated by two radiologists. Development of AVN was determined through radiographic findings at 1 year after reduction. Results AVN of the femoral head developed in 13 (22%) of 58 patients. Excessive abduction of the hip joint (OR 4.65, [95% CI 1.20, 18.06] and global decreased enhancement of the femoral head (OR 71.66, [95% CI 10.54, 487.31]) exhibited statistically significant differences between the AVN and non-AVN groups (P < 0.05). Eccentric reduction (P = 0.320) did not show statistically significant difference between two groups and invisible ossific nucleus (P = 0.05) showed borderline significance. Multi-variable logistic regression indicated that global decreased enhancement of the femoral head was a significant risk factor of AVN (OR 27.92, 95% CI [4.17, 350.18]) (P = 0.0031). Interobserver agreement of contrast enhancement pattern analysis and diagnosis of AVN were good (0.66, 95% CI [0.52, 0.80]). Conclusion Contrast-enhanced hip MRI provides accurate anatomical assessment of the hip after closed reduction of DDH. Global decreased enhancement of the femoral head could be used as a good predictor for future development of AVN after closed reduction of DDH.

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“…After reading the full text of the remaining 61 studies, three reviews and four meta-analysis studies were excluded, 13 studies were excluded because of missing or fuzzy data, 4 studies with duplicate data were excluded, 15 studies with an age of reduction ≥3 years old were excluded, and 8 studies involving only one treatment method were excluded. Finally, 14 articles [15,17,[22][23][24][25][26][27][28][29][30][31][32][33] were included. The literature retrieval process is illustrated in Fig.…”

Section: Study Selectionmentioning

confidence: 99%

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

Qiu

Chen²,

Sun³

et al. 2021

Journal of Pediatric Orthopaedics B

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The objective of this study was to evaluate the incidence of avascular necrosis (AVN) of the femoral head in children less than 3 years of age with developmental dysplasia of the hip (DDH) treated with closed reduction, open reduction alone and open reduction combined with osteotomy. We reviewed clinical trials from the PubMed, EMBASE and Cochrane Library databases (up to November 2020) that were related to closed reduction, open reduction alone and open reduction combined with osteotomy for the treatment of children under 3 years of age with DDH. The screening and quality evaluation of the literature were performed independently by two researchers. In case of disagreement, a third researcher resolved the discourse. Finally, the data were extracted, and the R software and GeMTC program package were used to conduct a network meta-analysis (NMA). The evaluation index was the incidence of AVN. Fourteen articles were included. The NMA showed that in terms of the incidence of AVN, cases treated with open reduction alone were higher than those with closed reduction, and the difference was statistically significant. Open reduction alone had the highest probability (94.4%) of having the highest incidence of AVN, followed by open reduction combined with osteotomy (5.5%) and closed reduction (0.1%). In the treatment of children with DDH who are younger than 3 years old, open reduction alone is most likely to be the treatment with the highest incidence of AVN, followed by open reduction combined with osteotomy. The closed reduction had the smallest probability of AVN.

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Developmental dysplasia of the hip: can contrast-enhanced MRI predict the development of avascular necrosis following surgery?

Cited by 7 publications

References 29 publications

Assessment of irreducible aspects in developmental hip dysplasia by magnetic resonance imaging

Assessment of irreducible aspects in developmental hip dysplasia by magnetic resonance imaging

MRI risk factors for development of avascular necrosis after closed reduction of developmental dysplasia of the hip: Predictive value of contrast-enhanced MRI

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

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