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International Orthopaedics

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11-10-2023 | Hip Dysplasia | Original Paper

Risk factor analysis of femoral avascular necrosis after operation for Tönnis grade IV developmental dysplasia of the hip

Authors: Qingjie Wu, Yangyang Li, Yudong Lin, Xiwei Sun, Hailong Ma, Jun Sun, Sicheng Zhang

Published in: International Orthopaedics | Issue 4/2024

Abstract

Purpose

We explored the risk factors for avascular necrosis (AVN) after surgery using open reduction, pelvic osteotomy, and femoral osteotomy for Tönnis grade IV developmental dysplasia of the hip (DDH).

Methods

In this retrospective study, we collected data of patients with Tönnis grade IV DDH treated with open reduction and pelvic osteotomy combined with femoral osteotomy from January 2012 to May 2020. The patients were divided into the AVN group and non-AVN group using the Kalamchi–MacEwen classification system. The clinical and imaging data of the two groups were collected, and the possible risk factors were included in the analysis. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors and odds ratios of AVN.

Results

In all, 254 patients (mean age; 2.6±0.9 years, 278 hips) were included. The mean follow-up time was 3.8±1.5 years. A total of 89 hips (32%) were finally classified as AVN (Kalamchi–MacEwen II–IV). Univariate analysis showed significant associations with AVN for age (p=0.006), preoperative femoral neck anteversion (FAV) (p<0.001), femoral osteotomy length to dislocation height ratio (FDR) <1 (p<0.001), and the epiphyseal ossific nucleus diameter to the neck diameter ratio (ENR) <50% (p=0.009). Multivariate logistic regression analysis showed that only excessive preoperative FAV (OR: 1.04; 95% CI: 1.02–1.05; p<0.001) and FDR<1 (OR: 3.58; 95% CI: 2.03–6.31; p<0.001) were independent risk factors for femoral head necrosis.

Conclusion

Excessive preoperative FAV and FDR<1 are important risk factors for femoral AVN after open reduction, pelvic osteotomy, and femoral osteotomy for Tönnis grade IV DDH. For children with DDH with high dislocation and excessive FAV, clinicians should fully evaluate their condition and design more personalized treatment programs to prevent AVN.

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Title: Risk factor analysis of femoral avascular necrosis after operation for Tönnis grade IV developmental dysplasia of the hip
Authors: Qingjie Wu
Yangyang Li
Yudong Lin
Xiwei Sun
Hailong Ma
Jun Sun
Sicheng Zhang
Publication date: 11-10-2023
Publisher: Springer Berlin Heidelberg
Keyword: Hip Dysplasia
Published in: International Orthopaedics / Issue 4/2024
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-023-05996-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factor analysis of femoral avascular necrosis after operation for Tönnis grade IV developmental dysplasia of the hip

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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