Ossification of the femoral head at closed reduction for developmental dysplasia of the hip and its influence on the long-term outcome

Abstract

The management of developmental dysplasia of the hip, particularly the timing of closed reduction with regard to the presence of the femoral head ossific nucleus, is controversial. The clinical and radiological outcome was assessed in a strictly defined group of 48 hips in 42 patients with an average of 11.1 years follow-up. One hundred percent of patients had an excellent or good result at final follow-up; 8.3% showed evidence of avascular necrosis and six hips underwent further surgery after closed reduction. There was no relationship between the presence or absence of an ossific nucleus at the time of closed reduction and the final outcome. In this well-defined group, closed reduction is safe and provides excellent results in the long term.

Avascular necrosis following closed reduction for treatment of developmental dysplasia of the hip: A systematic review

“…Exclusion criteria for the studies included teratologic hips and prior attempts at closed reduction. Most were conducted at a single institution, one at two medical centers [15] and one at four centers [16]. Summary details of each of the studies are provided in Table 1.…”

Does Perfusion MRI After Closed Reduction of Developmental Dysplasia of the Hip Reduce the Incidence of Avascular Necrosis?

“…In their review of the literature, Cooper et al [8] found a wide range in reported AVN rates between 3% and 60%, which they attributed to variations in the definition of AVN and the length of followup. In a more recent sample [4,6,7,16,19,21,24,30,34], AVN rates varied more consistently between 7% and 36%, but again a wide variety of radiographic criteria was used to identify AVN. In this study, we used Salter criteria as did Tiderius et al [34].…”

“…Finally, residual dysplasia may increase the use of additional surgical interventions. Previously reported rates of further corrective surgery have varied between 13% and 76% [6,7,18,21,37] as a result of differences in individual surgeons' practices. Although our results compare favorably with those studies, our reported overall rate of 16% (12% in the pMRI group) likely underrepresents the true value as a result of a shorter duration of followup.…”

“…Clinical studies have remained mixed on the importance of the ossific nucleus. Although many studies looking at both open and closed reduction have shown a protective response with respect to its presence [4,6,27], studies looking more specifically at closed reduction have shown no effect [7,18,30,35]. Some studies have linked older age at treatment to an increased risk of AVN [30,35] and an increased rate of residual dysplasia [16], whereas others have concluded younger age has either no influence [3,16,18,27] or a negative effect on AVN rates [15,25].…”

Evidence-based Management of Developmental Dysplasia of the Hip

“…The noncontrolled series delayed treatment until the ossific nucleus was present or the patient reached 13 months of age and showed no increase in AVN compared with other series. However, Luhmann and colleagues 58,59 found no difference in the rates of AVN with respect to the presence or absence of the ossific nucleus. These results were supported by the same findings from a series by Cooke and colleagues.…”