Functional Outcomes in Children with Osteonecrosis Secondary to Treatment of Developmental Dysplasia of the Hip

Roposch, Andreas; Liu, Liang Q.; Offiah, A.C.; Wedge, John H.

doi:10.2106/jbjs.j.01623

Cited by 44 publications

(80 citation statements)

References 20 publications

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“…1 The search process is illustrated using a modified version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram [60]. [69,77,81], and five were Level IV (case series) [1,29,33,74,83]. One study was diagnostic Level IV (poor reference standard study) [6].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Sufficient subject-level data were available to exclude the following ineligible cases: four dislocations of the hip secondary to neuromuscular or teratologic causes [15,67], 188 hips treated by open reduction with concomitant pelvic osteotomy [8,10,19,20,29,31,33,38,46,59,69,74,95,96], and 280 hips treated by other ineligible interventions [23,64,85,94]. Additionally, one study [13] included 12 hips treated by medial open reduction that at least partly overlapped with a more recently published article [49].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Thirty-nine studies [1, 4, 6-8, 11, 13, 14, 16, 18-20, 23, 27, 29, 30, 34, 38, 40, 41, 45, 53, 54, 56, 61, 64, 67, 69, 72, 74, 77, 79, 81, 83-85, 89, 94, 96] [54], older than 6 months [5], between 6 and 18 months old [95], younger than 18 months [43], and younger than 24 months [87]; an anterior approach for patients 12 months or older [57,69]; and no operative treatment at all before 9 months of age [7].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Sixteen studies [1,4,5,11,14,27,49,53,56,61,62,65,69,88,94,95] statistically analyzed the relationship between age at reduction and the occurrence of osteonecrosis. The analyses of five studies [56,62,69,94,95] were based partly on data that did not reflect our definition of index reduction.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Diagnosis and treatment are hindered by a substantial interval between initial obstruction of the vascular supply and onset of discernible radiographic anomalies [17]. Osteonecrosis has been reported to compromise acetabular development after hip reduction and is associated with poor long-term clinical, functional, and radiographic outcomes [30,42,69,71,91].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis

Novais

Hill

Carry

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Osteonecrosis of the femoral head is a major complication that negatively impacts the clinical and radiographic long-term outcome after treatment of developmental hip dysplasia (DDH). There are conflicting results in the literature whether age at the time of closed or open reduction and a specific surgical approach are associated with osteonecrosis. Better understanding of the impact of age at reduction and surgical approach is important to reduce the risk of osteonecrosis in patients with DDH. Questions/purposes We aimed to evaluate the association between occurrence of osteonecrosis and (1) age at closed reduction; (2) age at open reduction; and (3) medial versus anterior operative approaches.Methods A systematic review identified studies reporting osteonecrosis occurrence after treatment of DDH and at least 2 years of followup. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Methodologic quality was assessed using the methodologic index for nonrandomized studies. Generalized logistic models were used to estimate pooled odds ratios (ORs) in the meta-analysis. Sixty-six studies were included in the systematic review and 24 in the meta-analysis. Data on 481 hips treated by closed reduction and 584 hips treated by open reduction were available to evaluate the association between osteonecrosis and age. The association between osteonecrosis and operative approach was assessed using data on 364 hips treated by medial open reduction and 220 hips treated by anterior open reduction. Results Age at reduction ([ 12 months versus B 12 months) was not associated with osteonecrosis after closed reduction (OR, 1.1; 95% confidence interval [CI], 0.4-3.2; p = 0.9) or open reduction (OR, 1.1; 95% CI, 0.7-1.9; p = 0.66). The overall, adjusted incidence of osteonecrosis (C Grade II) was 8.0% (95% CI, 2.8%-20.6%) among patients treated with closed reduction at or before 12 months of age and 8.4% (95% CI, 3.0%-21.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis

Novais

Hill

Carry

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Loading rates during walking in adolescents with type II osteonecrosis secondary to pelvic osteotomy

Wang

Chen

et al. 2016

Journal Orthopaedic Research

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Although Pemberton osteotomy has shown a high success rate even in older children, the occurrence of osteonecrosis (ON) remains one of the most severe complications, leading to premature osteoarthritis. Patients with type II ON are characterized by a valgus deformity of the proximal femur with altered musculoskeletal conditions, affecting the ability to attenuate or sustain the impulsive loading from the ground reaction force. It remains unclear whether these conditions also predispose these patients to harmful impulsive loadings. This study aimed to bridge the gap by measuring the loading rates in the lower limbs during level walking in adolescents who were treated during their infancy for unilateral developmental dysplasia of the hip by a pelvic osteotomy, with or without having developed type II ON. Patients with type II ON were found to display increased loading rates, not only at both the affected and unaffected hip, but also at other joints of the affected limb during level walking when compared to patients without ON changes (p < 0.05). These results suggest that patients with type II ON may be at a higher risk of developing premature hip osteoarthritis that is closely related to abnormal loading rates during gait. It is suggested that regular monitoring of joint loading rates in patients with type II ON is necessary for early identification of damaging loadings, and that early intervention aimed at reducing these loadings should be considered. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2199-2206, 2016.

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Imaging of developmental dysplasia of the hip: ultrasound, radiography and magnetic resonance imaging

et al. 2019

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Functional Outcomes in Children with Osteonecrosis Secondary to Treatment of Developmental Dysplasia of the Hip

Cited by 44 publications

References 20 publications

Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis

Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis

Loading rates during walking in adolescents with type II osteonecrosis secondary to pelvic osteotomy

Imaging of developmental dysplasia of the hip: ultrasound, radiography and magnetic resonance imaging

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