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The Presence of an Ossific Nucleus Does Not Protect Against Osteonecrosis After Treatment of Developmental Dysplasia of the Hip

  • Clinical Research
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Clinical Orthopaedics and Related Research®

Abstract

Background

Osteonecrosis (ON) is a major complication after treatment of developmental dysplasia of the hip (DDH). Several studies have explored the absence of the femoral head ossific nucleus at the time of hip reduction as a risk factor for the development of ON, but findings have been inconsistent.

Questions/purposes

We therefore determined the incidence of ON in children who underwent reduction of a dislocated hip in the presence or absence of the ossific nucleus.

Patients and Methods

We retrospectively reviewed the radiographs of 105 hips in 89 patients treated for DDH at the age of 18 months or younger. Radiographs were graded for the presence of the ossific nucleus at the time of hip reduction and for the presence of ON, as graded by the Bucholz and Ogden classification, for patients at a mean age of 10 years. We used log-binomial regression to estimate if the presence of the ossific nucleus was associated with a lower incidence of ON.

Results

We identified ON in 37 of the 105 hips (35%). The incidence of ON at 10 years was 40% in the absence of the ossific nucleus and 32% in the presence of the ossific nucleus (adjusted relative risk, 0.86; 95% confidence interval, 0.36–1.81). When only radiographic changes of Grade II and greater were considered ON, the risk was still not increased (relative risk, 1.26; 95% confidence interval, 0.62–2.56).

Conclusion

Patients with an ossific nucleus at the time of hip reduction showed a slight tendency toward better outcomes. The ossific nucleus did not protect for ON.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank D.H.A. Jones and J. Fixsen whose former patients were part of this research.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK

    Andreas Roposch MD, MSc, FRCS

  2. Institute of Child Health, University College London, London, UK

    Andreas Roposch MD, MSc, FRCS & Odeh Odeh MB, BCh

  3. Department of Diagnostic Imaging, Hospital for Sick Children, and University of Toronto, Toronto, Canada

    Andrea S. Doria MD, MSc, PhD

  4. Division of Orthopaedic Surgery, Hospital for Sick Children, and University of Toronto, Toronto, Canada

    John H. Wedge OC, MD, FRCSC

Authors
  1. Andreas Roposch MD, MSc, FRCS
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  2. Odeh Odeh MB, BCh
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  3. Andrea S. Doria MD, MSc, PhD
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  4. John H. Wedge OC, MD, FRCSC
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Corresponding author

Correspondence to Andreas Roposch MD, MSc, FRCS.

Additional information

One or more of the authors has received funding from Royal College of Surgeons of England (AR, OO) and Arthritis Research UK (AR).

Each author certifies that his institution has approved for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Institute of Child Health, University College London, London, UK.

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Roposch, A., Odeh, O., Doria, A.S. et al. The Presence of an Ossific Nucleus Does Not Protect Against Osteonecrosis After Treatment of Developmental Dysplasia of the Hip. Clin Orthop Relat Res 469, 2838–2845 (2011). https://doi.org/10.1007/s11999-011-1801-6

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  • DOI: https://doi.org/10.1007/s11999-011-1801-6

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