Long-term outcome following medial open reduction in developmental dysplasia of the hip: A retrospective cohort study. (June 2016)

• Record Type: Journal Article
• Authors: Gardner, Richard O. E.; Bradley, Catharine S.; Sharma, Om P.; Feng, Lin; Shin, Michelle Eyun Jung; Kelley, Simon P.; Wedge, J. H.
• Is Part Of: Journal of children's orthopaedics. Volume 10:Number 3(2016)
• Page Start: 179
• Page End: 184
• Publication Date: 2016-06
• Subjects: Developmental dysplasia of the hip -- Hip dislocation -- Medial open reduction -- Avascular necrosis; Pediatric orthopedics -- Periodicals; 618.927005
• DOI: 10.1007/s11832-016-0729-5
• Languages: English
• ISSNs: 1863-2521

Abstract

Introduction: Avascular necrosis (AVN) is a serious complication of treatment for developmental dysplasia of the hip. There is ongoing controversy regarding AVN and its influence on hip development following medial open reduction (MOR). Purpose: The aim of our study was to (1) determine the long-term prevalence of AVN following MOR, (2) evaluate hip development after MOR, and (3) identify predictors of AVN and radiographic outcome at skeletal maturity after MOR. Methods: A retrospective cohort analysis of 60 patients (70 hips) who underwent MOR with a mean follow-up of 10.83 years (5.23–16.74) was conducted. AVN was recorded according to Bucholz and Ogden classification and radiographic outcome based on Severin grading. AVN and hip morphology related to length of follow-up were evaluated. Chi-squared and t -tests were used to identify relationships between AVN and other variables. Logistic regression was used to assess predictors of AVN and Severin outcome. Results: The rate of clinically significant AVN (types 2–4) following MOR was 32.9 % with type 2 accounting for 82.6 % of these cases. While early acetabular development was satisfactory, long-term outcome was unsatisfactory in 26 % of cases with AVN (vs 8.7 % of cases without AVN). A higher rate of AVN was identified when hips were immobilized in ≥60° of abduction postoperatively. A higher rate of poor Severin outcome was identified in hips with AVN. Conclusions: Our findings suggest that there is a high rate of AVN and unsatisfactory long-term outcome following MOR. AVN remains a significant concern following MOR surgery for developmental dysplasia of the hip that may not be apparent until long-term evaluation.