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Developmental Dysplasia of the Hip: Open Reduction as a Risk Factor for Substantial Osteonecrosis

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Kalamchi and MacEwen (K&M) described a four-group scheme for classifying osteonecrosis (ON) following treatment for developmental dysplasia of the hip (DDH). However, the four groups can overlap in radiographic appearance, making assessment difficult.

Questions/purposes

We (1) describe a simplified K&M classification; (2) determined whether the simplified classification was reliable; and (3) assessed whether differences in the type of reduction or age at reduction resulted in different degrees of ON.

Patients and Methods

We retrospectively reviewed 300 patients with DDH treated with either open or closed reduction. We included 101 of these patients (133 involved hips). Intraobserver and interobserver reliability testing of the original and our simplified classification was performed. ON occurred in 64 hips (48%). Of these, 22 had original K&M Group I disease (classified as simplified Group A), and 42 had original K&M Groups II, III, or IV disease (classified as simplified Group B). The mean age of the patients at final followup was 12.4 years (range, 6–26.3 years).

Results

The interobserver reliability of the simplified classification was greater than that of the K&M classification (0.51 vs 0.33, respectively). Closed reduction after skin traction resulted in a lower incidence of Group B ON than open reduction, regardless of age at reduction.

Conclusions

We propose a simplified and more reliable classification of ON after DDH. With the new classification we found type of reduction (closed with traction versus open without femoral shortening) but not age influenced the risk of ON.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Agus H, Omeroglu H, Ucar H, Bicimoglu A, Turmer Y. Evaluation of the risk factors of avascular necrosis of the femoral head in developmental dysplasia of the hip in infants younger than 18 months of age. J Pediatr Orthop B. 2002;11:41–46.

    Article  PubMed  Google Scholar 

  2. Albinana J, Dolan LA, Spratt KF, Morcuende J, Meyer MD, Weinstein SL. Acetabular dysplasia after treatment for developmental dysplasia of the hip: implications for secondary procedures. J Bone Joint Surg Br. 2004;86:876–886.

    Article  CAS  PubMed  Google Scholar 

  3. 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.

    CAS  PubMed  Google Scholar 

  4. Bucholz RW, Ogden JA. Patterns of ischaemic 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: CV Mosby Co; 1978:43–63.

  5. Canale ST, Beaty J. Campbell’s Operative Orthopaedics. Ed 10. St Louis, MO: CV Mosby Co; 2007:1089–1091.

  6. 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.

    CAS  PubMed  Google Scholar 

  7. Cordier W, Tönnis D, Kalchschmidt K, Storch KJ, Katthagen BD. Long-term results after open reduction of developmental hip dislocation by an anterior approach lateral and medial of the iliopsoas muscle. J Pediatr Orthop B. 2005;14:79–87.

    PubMed  Google Scholar 

  8. Domzalski M, Synder M. Avascular necrosis after surgical treatment for developmental dysplasia of the hip. Int Orthop. 2004;28:65–68.

    Article  PubMed  Google Scholar 

  9. Gage JR, Winter RB. Avascular necrosis of the capital femoral epiphysis as a complication of closed reduction of congenital dislocation of the hip: a critical review of twenty years’ experience at Gillette Children’s Hospital. J Bone Joint Surg Am. 1972;54:373–388.

    CAS  PubMed  Google Scholar 

  10. Hirohashi K, Kambara T, Narushima M, Lee Y, Shimazu A. A radiographic study of ischemic necrosis following the treatment of CDH. J Jpn Orthop Assoc. 1982;56:927–928.

    Google Scholar 

  11. Isiklar ZU, Kandemir U, Ucar DH, Tumer Y. Is concomitant bone surgery necessary at the time of open reduction in developmental dislocation of the hip in children 12–18 months old? Comparison of open reduction in patients younger than 12 months old and those 12–18 months old. J Pediatr Orthop B. 2006;15:23–27.

    PubMed  Google Scholar 

  12. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1980;62:876–888.

    CAS  PubMed  Google Scholar 

  13. Keret D, MacEwen GD. Growth disturbance of the proximal part of the femur after treatment for congenital dislocation of the hip. J Bone Joint Surg Am. 1991;73:410–423.

    CAS  PubMed  Google Scholar 

  14. Kim HW, Morcuende JA, Dolan LA, Weinstein SL. Acetabular development in developmental dysplasia of the hip complicated by lateral growth disturbance of the capital femoral epiphysis. J Bone Joint Surg Am. 2000;82:1692–1700.

    PubMed  Google Scholar 

  15. Kramer J, Schleberger R, Steffen R. Closed reduction by two-phase skin traction and functional splinting in mitigated abduction for treatment of congenital dislocation of the hip. Clin Orthop Relat Res. 1990;258:27–32.

    PubMed  Google Scholar 

  16. Luhmann SJ, Bassett GS, Gordon JE, Schootman M, Schoenecker PL. Reduction of a dislocation of the hip due to developmental dysplasia: implications for the need for future surgery. J Bone Joint Surg Am. 2003;85:239–243.

    PubMed  Google Scholar 

  17. Macnicol M, Bertol P. The Salter innominate osteotomy: should it be combined with concurrent open reduction? J Pediatr Orthop B. 2005;14:415–421.

    PubMed  Google Scholar 

  18. 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.

    CAS  PubMed  Google Scholar 

  19. Rampal V, Sabourin M, Erdeneshoo E, Koureas G, Seringe R, Wicart P. Closed reduction with traction for developmental dysplasia of the hip in children aged between one and five years. J Bone Joint Surg Br. 2008;90:858–863.

    Article  CAS  PubMed  Google Scholar 

  20. Roposch A, Stöhr 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.

    Article  PubMed  Google Scholar 

  21. Salter RB, Kostuik J, Dallas S. Avascular necrosis of the femoral head as a complication of treatment for congenital dislocation of the hip in young children: a clinical and experimental investigation. Can J Surg. 1969;12:44–61.

    CAS  PubMed  Google Scholar 

  22. Sibinski M, Synder M. Lateral growth disturbances of the capital femoral epiphysis after nonoperative treatment of late developmental dislocation of the hip: thirty-five cases followed to skeletal maturity. J Pediatr Orthop. 2006;26:307–309.

    PubMed  Google Scholar 

  23. Thomas IH, Dunin AJ, Cole WG, Menelaus MB. Avascular necrosis after open reduction for congenital dislocation of the hip: analysis of causative factors and natural history. J Pediatr Orthop. 1989;9:525–531.

    CAS  PubMed  Google Scholar 

  24. Thomas SR, Wedge JH, Salter RB. Outcome at forty-five years after open reduction and innominate osteotomy for late-presenting developmental dislocation of the hip. J Bone Joint Surg Am. 2007;89:2341–2350.

    Article  PubMed  Google Scholar 

  25. Weinstein SL. Natural history of congenital hip dislocation (CDH) and hip dysplasia. Clin Orthop Relat Res. 1987;225:62–76.

    PubMed  Google Scholar 

  26. Wenger DR, Lee CS, Kolman B. Derotational femoral shortening for developmental dislocation of the hip: special indications and results in the child younger than 2 years. J Pediatr Orthop. 1995;15:768–779.

    CAS  PubMed  Google Scholar 

  27. Zionts LE, MacEwen GD. Treatment of congenital dislocation of the hip in children between the ages of one and three years. J Bone Joint Surg Am. 1986;68:829–846.

    CAS  PubMed  Google Scholar 

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Acknowledgments

We thank Nick Barrowman and Locardia Kuwanda for assistance with the statistical analysis.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Room 4M12, University of the Witwatersrand Medical School, 7 York Road, Parktown, Johannesburg, 2193, South Africa

    G. B. Firth MBBCh, FCS (Orth) (SA), MMed (Orth) (Wits), A. J. F. Robertson MBBCh, MMed (Orth) (Wits) & A. Schepers MBBCh, FRCS (Ed)

  2. School of Statistics and Actuarial Science, University of the Witwatersrand, Johannesburg, South Africa

    L. Fatti PhD

Authors
  1. G. B. Firth MBBCh, FCS (Orth) (SA), MMed (Orth) (Wits)
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  2. A. J. F. Robertson MBBCh, MMed (Orth) (Wits)
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  3. A. Schepers MBBCh, FRCS (Ed)
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Correspondence to G. B. Firth MBBCh, FCS (Orth) (SA), MMed (Orth) (Wits).

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Each author certifies that he or she has no 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.

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.

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Firth, G.B., Robertson, A.J.F., Schepers, A. et al. Developmental Dysplasia of the Hip: Open Reduction as a Risk Factor for Substantial Osteonecrosis. Clin Orthop Relat Res 468, 2485–2494 (2010). https://doi.org/10.1007/s11999-010-1400-y

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  • DOI: https://doi.org/10.1007/s11999-010-1400-y

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