Osteonecrosis Complicating Developmental Dysplasia of the Hip Compromises Subsequent Acetabular Remodeling

Roposch, Andreas; Ridout, Deborah; Protopapa, Evangelia; Nicolaou, N.; Gelfer, Yael

doi:10.1007/s11999-013-2804-2

Cited by 33 publications

(26 citation statements)

References 20 publications

(39 reference statements)

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“…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%

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: Introductionmentioning

confidence: 99%

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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“…The occurrence of ON is still a troublesome complication following the treatment of DDH. Even with the milder form, such as type II, the condition may eventually compromise the acetabular development . It has been advised that surgical correction for these ON‐related hip deformities should be performed early, otherwise the acetabular dysplasia may become permanent and may be difficult to salvage later on .…”

Section: Discussionmentioning

confidence: 99%

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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“…Literatürde %6-48 gibi değişik oranlarda görüldüğü bildirilmiştir. [22] Osteonekrozun varlığı asetabulum remodelizasyonunu da olumsuz yönde etkilemektedir. Özellikle tip 1 AVN'ye sıkça rastlanır.…”

Section: Discussionunclassified

Early-term hip development following Pemberton osteotomy: a radiological follow-up

Sarıkaya

Sipahioğlu

Sarıkaya

et al. 2016

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada Pemberton osteotomisi sonrası erken dönemde görülen radyolojik değişikliklerin kalça eklemi gelişimi ile olan ilişkisi değerlendirildi. Hastalar ve yöntemler:Ocak 2010 -Aralık 2014 tarihleri arasında yapılan bu çalışmaya gelişimsel kalça displazisi nedeniyle Pemberton osteotomisi uygulanan 75 hastanın (25 erkek, 50 kız; ort. yaş 31.5 ay; dağılım 15-71 ay) 101 kalçası (26 iki taraflı) dahil edildi. Radyolojik olarak merkez kenar açısı, asetabüler indeks (Aİ), asetabüler derinlik indeksi (ADİ) parametreleri değerlendirildi. Ön-arka pelvis grafilerinde femur başı kemikleşme merkezinin yüzey alanı ölçüldü. Kalça dislokasyon derecesi Tönnis sınıflandırmasına göre, femur başı avasküler nekrozu KalamchiMacEwen sınıflandırmasına göre derecelendirildi. Ameliyat edilen kalçalar tüm hastalarda ve sadece tek taraflı ameliyat edilen hastalarda takip sürelerine göre 12 ay, 12-24 ay ve 24 aydan fazla olmak üzere üç gruba ayrıldı. Tüm takip sürelerinde radyolojik parametrelerin ilişkileri incelendi. Bulgular: Ortalama takip süresi 22.5 ay (dağılım, 6-66 ay) idi. Ameliyat öncesi ortalama Aİ 42.25° (dağılım, 29°-60°), son takip ortalama Aİ 20.45° (dağılım, 10°-32°) idi. Ameliyat öncesi ortalama ADİ 16.48° (dağılım, 9°-30°), son takip ortalama ADİ 26.1° (dağılım, 23°-47°) idi. Altmış kalça Tönnis tip 4, 26 kalça tip 3 ve 15 kalça tip 2 idi. Takip süresi sınıflandırmasına göre; 12 ay takip süresi olan 32 kalça (21 tek taraf), 12-24 ay takip süresi olan 43 kalça (17 tek taraf) ve 24 aydan fazla takip süresi olan 26 kalça (11 tek taraf) vardı. On sekiz femura kısaltıcı osteotomi uygulandı. Kalamchi-MacEwen sınıflandırmasına göre; 16 kalçada tip 1, iki kalçada tip 2, üç kalçada tip 3, iki kalçada ise tip 4 avasküler nekroz vardı. Tekrar eden subluksasyonlar nedeniyle beş kalçada revizyon ameliyatı uygulandı.Sonuç: Pemberton osteotomisi sonrası erken dönemde, kalça eklemlerinde ve bunun sonucu olarak da radyolojik parametrelerde progresif düzelme görüldü.Anahtar sözcükler: Kalça displazisi; kalça çıkığı; Pemberton osteotomisi; radyolojik takip. ABSTRACTObjectives: This study aims to evaluate the relationship of early-term radiological changes with development of the hip joint after Pemberton osteotomy. Patients and methods:This study, which was conducted between January 2010 and December 2014, included 101 hips (26 bilateral) of 75 patients (25 males, 50 females; mean age 31.5 months; range 15 to 71 months) which were performed Pemberton osteotomy due to developmental dysplasia of the hip. Radiologically, we assessed the parameters of centeredge angle, acetabular index (AI), and acetabular depth index (ADI). We measured the surface area of the femoral head ossific nucleus on anteriorposterior pelvic X-rays. We graded the degree of hip dislocation according to Tönnis classification while the femoral head avascular necrosis was graded according to Kalamchi-MacEwen classification. We separated the operated hips in all patients and in only unilaterally operated patients in three groups according to their follow-up dura...

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Osteonecrosis Complicating Developmental Dysplasia of the Hip Compromises Subsequent Acetabular Remodeling

Cited by 33 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

Early-term hip development following Pemberton osteotomy: a radiological follow-up

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