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Does Open Reduction of the Developmental Dislocated Hip Increase the Risk of Osteonecrosis?

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

Abstract

Background

Osteonecrosis (ON) of the femoral head is one of the main complications associated with treatment of developmental dysplasia of the hips (DDH). The reported rates of ON vary widely between 6% and 48%, suggesting varying factors in these studies influence the rate. Several studies suggest open reduction combined with femoral shortening provides protection against ON. However, it is unclear whether confounders such as failed Pavlik harness treatment, preliminary traction, closed versus open reduction, and redislocation influence the rate of ON.

Questions/purpose

We therefore asked whether open reduction with concomitant osteotomies without femoral shortening, redislocation, and secondary surgical procedures for residual acetabular dysplasia influenced the rate of ON.

Methods

We retrospectively reviewed 64 children (78 hips) hospitalized with developmental dislocation of the hip between January 1998 and February 2007. Patients younger than 12 months were treated with closed or open reduction. Open reduction combined with concomitant pelvic and femoral osteotomies was performed in patients past walking age. ON was diagnosed from radiographs obtained at last followup. We used logistic regression analysis to identify predictors for the development of ON. The minimum followup was 3.2 years (mean, 6.8 years; range, 3.2−11.5 years).

Results

The overall rate of ON was 40%. Patients who underwent open reduction combined with concomitant osteotomies, experienced redislocation, or required secondary reconstructive procedures after initial reduction were at higher risk for having ON develop.

Conclusions

We advocate early reduction of the dislocated hip in the first year of life to avoid the need for concomitant osteotomies combined with open reduction.

Level of Evidence

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

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Acknowledgment

We thank Dori Kelly MA, for English language editing of the manuscript.

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Authors and Affiliations

  1. Pediatric Orthopaedic Department, Orthopaedic Hospital Vienna-Speising, Speisinger Strasse 109, 1130, Vienna, Austria

    Renata Pospischill MD, Julia Weninger MD, Rudolf Ganger MD, PhD, Johannes Altenhuber MD & Franz Grill MD

Authors
  1. Renata Pospischill MD
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  2. Julia Weninger MD
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  3. Rudolf Ganger MD, PhD
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  4. Johannes Altenhuber MD
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  5. Franz Grill MD
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Correspondence to Renata Pospischill MD.

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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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Pospischill, R., Weninger, J., Ganger, R. et al. Does Open Reduction of the Developmental Dislocated Hip Increase the Risk of Osteonecrosis?. Clin Orthop Relat Res 470, 250–260 (2012). https://doi.org/10.1007/s11999-011-1929-4

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  • DOI: https://doi.org/10.1007/s11999-011-1929-4

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