Published in:
Open Access
01-06-2016 | Original Clinical Article
Risk factors for avascular necrosis after closed reduction for developmental dysplasia of the hip
Authors:
Mathew D. Schur, Christopher Lee, Alexandre Arkader, Anthony Catalano, Paul D. Choi
Published in:
Journal of Children's Orthopaedics
|
Issue 3/2016
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Abstract
Purpose
The purpose of this study was to identify and evaluate risk factors of avascular necrosis (AVN) after closed treatment for developmental dysplasia of the hip (DDH).
Methods
A retrospective review of children diagnosed with DDH at a tertiary-care children’s hospital between 1986 and 2009 was performed. The presence of AVN was assessed according to Salter’s classification system.
Results
Eighty-two affected hips in 70 children with an average age of 10 months at closed reduction (range 1–31 months) and 5 years (range 2–19 years) of follow-up met the inclusion criteria. Twenty-nine (of 82, 35 %) affected hips developed AVN. The use of pre-reduction traction (p = 0.019) increased the risk of AVN, while preoperative Pavlik harness or brace trial (p = 0.28), presence of ossific nucleus at the time of closed reduction (p = 0.16), and adductor tenotomy (p = 0.37) were not significant factors. Laterality (right vs. left) was also not a significant risk factor (p = 0.75), but patients who underwent closed reduction for bilateral DDH were less likely to develop AVN (p = 0.027). Overall, the degree of abduction did not affect the rate of AVN (p = 0.87). However, in patients treated with closed reduction younger than 6 months of age, the rate of AVN was increased with abduction ≥50° (9/15, 60 %) compared to abduction <50° (0/8, 0 %) (p = 0.007). Patients who developed AVN were more likely to require subsequent surgery (p = 0.034) and more likely to report a fair/poor clinical outcome (p = 0.049).
Conclusions
The risk of AVN (35 %) following closed reduction and spica casting for DDH is high. The degree of abduction in spica casts appears to be a risk factor in patients ≤6 months old. The authors recommend that abduction in spica casts should be limited to <50° in children younger than 6 months of age.