Medial Adductor Open Reduction for Congenital Dislocation of the Hip

Castillo, Richard; Sherman, Frederick C.

doi:10.1097/01241398-199005000-00008

Cited by 54 publications

(50 citation statements)

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“…The rate of osteonecrosis after medial open reduction in our study was similar to the rate reported by Gardner et al [32]. In general, anterior open reduction has been the preferred approach for patients older than 24 months of age, whereas most authors restrict the indication of medial reduction for patients younger than 24 months of age [15,49,56,62,65,92]. Therefore, the most relevant clinical question that remains to be answered is as follows.…”

Section: Discussionsupporting

confidence: 87%

“…Contrary to our strict definition of index reduction, their analysis did not specify whether the age data were based on first and/or subsequent attempts at open reduction. They also included studies [15,47] with subjects without idiopathic DDH who were ineligible for our review. The controversy about the association between age at open reduction and osteonecrosis remains.…”

Section: Discussionmentioning

confidence: 99%

“…Thirty studies did not report osteonecrosis occurrence for all patients eligible for open or closed reduction specific to age at index reduction (12 months or younger versus older than 12 months). Ten studies [11,15,19,20,24,38,40,64,67,74] reported the age-specific occurrence of Grade I or greater osteonecrosis but not Grade II or greater osteonecrosis. One additional study [46] reported osteonecrosis occurrence by age at index open reduction but not by operative approach (medial versus anterior) and was excluded from the meta-analysis.…”

Section: Critical Reviewmentioning

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%

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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: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Critical Reviewmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 2 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

View full text Add to dashboard Cite

show abstract

“…Several observational studies examined the impact of age at the time of intervention. 25,81,95,[110][111][112][113] In 1 small study that included children initiating therapy for DDH from birth through 4 months of age, duration of treatment increased in a dose-response fashion as the age at initiation of treatment increased, holding the severity of DDH steady. 81 In a separate series of patients who underwent surgery for DDH (70% of whom had failed therapy with a Pavlik harness), those who were 6 to 9 months of age (18 patients) required no additional corrective surgeries, whereas 29% of the patients 10 to 11 months of age, 13% of patients 12 to 14 months of age, 26% of patients 15 to 18 months of age, and 30% of patients 19 to 24 months of age required additional surgical interventions.…”

Section: Biological Plausibilitymentioning

confidence: 99%