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Developmental dysplasia of the hip: can contrast-enhanced MRI predict the development of avascular necrosis following surgery?

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Abstract

Objective

To investigate the performance of contrast-enhanced MRI for predicting avascular necrosis (AVN) of the treated femoral head after surgical reduction for developmental dysplasia of the hip (DDH) using qualitative and quantitative methods.

Methods and materials

This IRB-approved, HIPAA compliant retrospective study included 47 children who underwent same-day contrast-enhanced MRI following unilateral surgical hip reduction between April 2009 and June 2018. Blinded to the clinical outcome, 3 reviewers (2 pediatric radiologists and 1 pediatric orthopedist) independently categorized the enhancement pattern of the treated femoral head. Signal intensities, measured using regions of interest (ROI), were compared between treated and untreated hips and percent enhancements were compared between hips that developed and did not develop AVN. Post-reduction radiographs were evaluated using Salter’s criteria for AVN and Kalmachi and MacEwen’s classification for growth disturbance. Non-parametric tests and Fisher exact test were used to compare enhancement values between AVN and non-AVN hips. Bonferroni correction was used for multiple comparisons.

Results

Ten (21%) out of the 47 children (7 boys and 40 girls; mean age 9.0 ± 4.7 months) developed AVN. Age at surgical reduction was significantly higher (p = 0.03) for hips that developed AVN. No significant differences were found in gender (p = 0.61), laterality (p = 0.46), surgical approach (p = 0.08), history of pre-operative bracing (p = 0.72), abduction angle (p = 0.18–0.44), enhancement pattern (p = 0.66–0.76), or percent enhancement (p = 0.41–0.88) between AVN and non-AVN groups.

Conclusion

Neither enhancement pattern nor percent enhancement predicted AVN, suggesting that post-reduction conventional MRI does not accurately distinguish between reversible and permanent vascular injury.

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Authors and Affiliations

  1. Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Jie C. Nguyen, Susan J. Back, Christian A. Barrera, Michael K. Nguyen & Shijie Hong

  2. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Jie C. Nguyen, Susan J. Back & Wudbhav N. Sankar

  3. Cooper Medical School of Rowan University, Camden, NJ, USA

    Maya Patel

  4. Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Wudbhav N. Sankar

Authors
  1. Jie C. Nguyen
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  2. Susan J. Back
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  3. Christian A. Barrera
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  4. Maya Patel
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  5. Michael K. Nguyen
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Correspondence to Jie C. Nguyen.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Children’s Hospital of Philadelphia’s institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was not required for this retrospective study according to the Children’s Hospital of Philadelphia’s IRB.

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Nguyen, J.C., Back, S.J., Barrera, C.A. et al. Developmental dysplasia of the hip: can contrast-enhanced MRI predict the development of avascular necrosis following surgery?. Skeletal Radiol 50, 389–397 (2021). https://doi.org/10.1007/s00256-020-03572-z

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