Abstract
Background
Osteonecrosis of the femoral head secondary to treatment of developmental dysplasia of the hip (DDH) affects acetabular remodeling but the magnitude of this effect is unclear.
Questions/purposes
Using four measures of acetabular development, we (1) determined whether acetabular remodeling differed in hips with and without osteonecrosis; and (2) determined the impact of severity of osteonecrosis contributing to acetabular remodeling.
Methods
We retrospectively reviewed 95 patients (118 hips) treated for DDH by closed or open reduction with or without femoral osteotomy between 1992 and 2006. We evaluated serial radiographs from the time when a stable reduction had been achieved. In 902 radiographs taken over 19 years, we measured the acetabular index and three other indices of hip development. Patients were followed for a mean of 8 years (range, 1–19 years). At last followup, 86 of the 118 hips (73%) had osteonecrosis according to the criteria by Bucholz and Ogden.
Results
The acetabular index improved with time in all hips but the magnitude of improvement was larger in hips without osteonecrosis. The adjusted mean acetabular index at 14 years was 17° for hips with osteonecrosis (95% CI, 15°–18°) and 10° for hips without osteonecrosis (95% CI, 7°–13°). The lateral centering ratio improved after reduction to a normal value less than 0.85 in both groups but the rate of change with 0.06 versus 0.05 was higher in hips with osteonecrosis. The superior centering ratio was worse at all times in hips with osteonecrosis with a mean difference of 0.04. If only radiographic changes of Grades II and greater were considered osteonecrosis, the mean adjusted acetabular index at 14 years was 17.7° (15.6°–19.7°) for hips with osteonecrosis and 12.4° (10.3°–14.4°) for hips without osteonecrosis.
Conclusions
Although radiographic indices improved consistently with time in hips without osteonecrosis, hips with osteonecrosis had abnormal indices of acetabular remodeling throughout followup. Osteonecrosis of the femoral head inhibited acetabular remodeling.
Level of Evidence
Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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References
Akaike H. A new look at the statistical model identification. IEEE Trans. 1974;19:716–723.
Albinana J, Dolan LA, Spratt KF, Morcuende J, Meyer MD, Weinstein SL. Acetabular dysplasia after treatment for developmental dysplasia of the hip. J Bone Joint Surg Br. 2004;86:876–886.
Atsumi T, Kuroki Y. Role of impairment of blood supply of the femoral head in the pathogenesis of idiopathic osteonecrosis. Clin Orthop Relat Res. 1992;277:22–30.
Bar-On E, Huo MH, DeLuca PA. Early innominate osteotomy as a treatment for avascular necrosis complicating developmental hip dysplasia. J Pediatr Orthop B. 1997;6:138–145.
Brougham DI, Broughton NS, Cole WG, Menelaus MB. The predictability of acetabular development after closed reduction for congenital dislocation of the hip. J Bone Joint Surg Br. 1988;70:733–736.
Brougham DI, Broughton NS, Cole WG, Menelaus MB. Avascular necrosis following closed reduction of congenital dislocation of the hip: review of influencing factors and long-term follow-up. J Bone Joint Surg Br. 1990;72:557–562.
Bucholz RW, Ogden JA. Patterns of ischemic necrosis of the proximal femur in nonoperatively treated congenital hip disease. The Hip: Proceedings of the Sixth Open Scientific Meeting of the Hip Society. St Louis, MO: Mosby; 1978:43–63.
Cooperman DR, Wallensten R, Stulberg SD. Post-reduction avascular necrosis in congenital dislocation of the hip. J Bone Joint Surg Am. 1980;62:247–258.
Cooperman DR, Wallensten R, Stulberg SD. Acetabular dysplasia in the adult. Clin Orthop Relat Res. 1983;175:79–85.
Harris NH, Lloyd-Roberts GC, Gallien R. Acetabular development in congenital dislocation of the hip: with special reference to the indications for acetabuloplasty and pelvic or femoral realignment osteotomy. J Bone Joint Surg Br. 1975;57:46–52.
Lindstrom JR, Ponseti IV, Wenger DR. Acetabular development after reduction in congenital dislocation of the hip. J Bone Joint Surg Am. 1979;61:112–118.
Malvitz TA, Weinstein SL. Closed reduction for congenital dysplasia of the hip: functional and radiographic results after an average of thirty years. J Bone Joint Surg Am. 1994;76:1777–1792.
Morcuende J, Meyer MD, Dolan LA, Weinstein SL. Long-term outcome after open reduction through an anteromedial approach for congenital dislocation of the hip. J Bone Joint Surg Am. 1997;79;810–817.
Nakamura J, Kamegaya M, Saisu T, Someya M, Koizumi W, Moriya H. Treatment for developmental dysplasia of the hip using the Pavlik harness: long-term results. J Bone Joint Surg Br. 2007;89:230–235.
Roposch A, Liu LQ, Offiah A, Wedge JH. Functional outcomes in children with osteonecrosis secondary to developmental dysplasia of the hip. J Bone Joint Surg Am. 2011;93:e145.
Roposch A, Stohr KK, Dobson M. The effect of the femoral head ossific nucleus in the treatment of developmental dysplasia of the hip: a meta-analysis. J Bone Joint Surg Am. 2009;91:911–918.
Royston P, Ambler G, Sauerbrei W. The use of fractional polynomials to model continuous risk variables in epidemiology. Int J Epidemiol. 1999;28:964–974.
Sharp IK. Acetabular dysplasia: the acetabular angle. J Bone Joint Surg Br. 1961;43:268–272.
Sibinski M, Synder M, Pruszczynski B. [Hip joint development after closed reduction complicated by growth disturbance of the capital femoral epiphysis][in Polish]. Chir Nazardow Ruchu Orto Pol. 2006;71:33–36.
Skaggs DL, Kaminsky C, Tolo VT, Kay RM, Reynolds RA. Variability in measurement of acetabular index in normal and dysplastic hips, before and after reduction. J Pediatr Orthop. 1998;18:799–801.
Spence G, Hocking R, Wedge JH, Roposch A. Effect of innominate and femoral varus derotation osteotomy on acetabular development in developmental dysplasia of the hip. J Bone Joint Surg Am. 2009;91:2622–2636.
Tönnis D. Normal values of the hip joint for evaluation of x-rays in children and adults. Clin Orthop Relat Res. 1976;119:39–47.
Tönnis D. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. 1st ed. Berlin, Germany: Springer-Verlag; 1987.
Ucar DH, Isiklar ZU, Stanitski CL, Kandemir U, Tumer Y. Open reduction through a medial approach in developmental dislocation of the hip: a follow-up study to skeletal maturity. J Pediatr Orthop. 2004;24:493–500.
White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30:377–399.
Zeger SL, Liang KY, Albert PS. Models for longitudinal data: a generalized estimating equation approach. Biometrics. 1988;44:1049–1060.
Acknowledgments
We thank John H. Wedge OC MD FRCS(C) for help in grading radiographs for the presence of osteonecrosis and David H. Jones FRCS for permission to include his former patients in this study.
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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at the Institute of Health, University College London, and Great Ormond Street Hospital for Children, London, UK.
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Roposch, A., Ridout, D., Protopapa, E. et al. Osteonecrosis Complicating Developmental Dysplasia of the Hip Compromises Subsequent Acetabular Remodeling. Clin Orthop Relat Res 471, 2318–2326 (2013). https://doi.org/10.1007/s11999-013-2804-2
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DOI: https://doi.org/10.1007/s11999-013-2804-2