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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 7/2013

01-07-2013 | Clinical Research

Osteonecrosis Complicating Developmental Dysplasia of the Hip Compromises Subsequent Acetabular Remodeling

Authors: Andreas Roposch, MD, MSc, FRCS, Deborah Ridout, MSc, Evangelia Protopapa, MSc, Nicholas Nicolaou, FRCS, Yael Gelfer, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 7/2013

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Abstract

Background

Osteonecrosis of the femoral head secondary to treatment of developmental dysplasia of the hip (DDH) affects acetabular remodeling but the magnitude of this effect is unclear.

Questions/purposes

Using four measures of acetabular development, we (1) determined whether acetabular remodeling differed in hips with and without osteonecrosis; and (2) determined the impact of severity of osteonecrosis contributing to acetabular remodeling.

Methods

We retrospectively reviewed 95 patients (118 hips) treated for DDH by closed or open reduction with or without femoral osteotomy between 1992 and 2006. We evaluated serial radiographs from the time when a stable reduction had been achieved. In 902 radiographs taken over 19 years, we measured the acetabular index and three other indices of hip development. Patients were followed for a mean of 8 years (range, 1–19 years). At last followup, 86 of the 118 hips (73%) had osteonecrosis according to the criteria by Bucholz and Ogden.

Results

The acetabular index improved with time in all hips but the magnitude of improvement was larger in hips without osteonecrosis. The adjusted mean acetabular index at 14 years was 17° for hips with osteonecrosis (95% CI, 15°–18°) and 10° for hips without osteonecrosis (95% CI, 7°–13°). The lateral centering ratio improved after reduction to a normal value less than 0.85 in both groups but the rate of change with 0.06 versus 0.05 was higher in hips with osteonecrosis. The superior centering ratio was worse at all times in hips with osteonecrosis with a mean difference of 0.04. If only radiographic changes of Grades II and greater were considered osteonecrosis, the mean adjusted acetabular index at 14 years was 17.7° (15.6°–19.7°) for hips with osteonecrosis and 12.4° (10.3°–14.4°) for hips without osteonecrosis.

Conclusions

Although radiographic indices improved consistently with time in hips without osteonecrosis, hips with osteonecrosis had abnormal indices of acetabular remodeling throughout followup. Osteonecrosis of the femoral head inhibited acetabular remodeling.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
Akaike H. A new look at the statistical model identification. IEEE Trans. 1974;19:716–723.
2.
Albinana J, Dolan LA, Spratt KF, Morcuende J, Meyer MD, Weinstein SL. Acetabular dysplasia after treatment for developmental dysplasia of the hip. J Bone Joint Surg Br. 2004;86:876–886.PubMedCrossRef
3.
Atsumi T, Kuroki Y. Role of impairment of blood supply of the femoral head in the pathogenesis of idiopathic osteonecrosis. Clin Orthop Relat Res. 1992;277:22–30.PubMed
4.
Bar-On E, Huo MH, DeLuca PA. Early innominate osteotomy as a treatment for avascular necrosis complicating developmental hip dysplasia. J Pediatr Orthop B. 1997;6:138–145.PubMedCrossRef
5.
Brougham DI, Broughton NS, Cole WG, Menelaus MB. The predictability of acetabular development after closed reduction for congenital dislocation of the hip. J Bone Joint Surg Br. 1988;70:733–736.PubMed
6.
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.PubMed
7.
Bucholz RW, Ogden JA. Patterns of ischemic 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: Mosby; 1978:43–63.
8.
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.PubMed
9.
Cooperman DR, Wallensten R, Stulberg SD. Acetabular dysplasia in the adult. Clin Orthop Relat Res. 1983;175:79–85.PubMed
10.
Harris NH, Lloyd-Roberts GC, Gallien R. Acetabular development in congenital dislocation of the hip: with special reference to the indications for acetabuloplasty and pelvic or femoral realignment osteotomy. J Bone Joint Surg Br. 1975;57:46–52.PubMed
11.
Lindstrom JR, Ponseti IV, Wenger DR. Acetabular development after reduction in congenital dislocation of the hip. J Bone Joint Surg Am. 1979;61:112–118.PubMed
12.
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.PubMed
13.
Morcuende J, Meyer MD, Dolan LA, Weinstein SL. Long-term outcome after open reduction through an anteromedial approach for congenital dislocation of the hip. J Bone Joint Surg Am. 1997;79;810–817.PubMed
14.
Nakamura J, Kamegaya M, Saisu T, Someya M, Koizumi W, Moriya H. Treatment for developmental dysplasia of the hip using the Pavlik harness: long-term results. J Bone Joint Surg Br. 2007;89:230–235.PubMed
15.
Roposch A, Liu LQ, Offiah A, Wedge JH. Functional outcomes in children with osteonecrosis secondary to developmental dysplasia of the hip. J Bone Joint Surg Am. 2011;93:e145.PubMedCrossRef
16.
Roposch A, Stohr 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.PubMedCrossRef
17.
Royston P, Ambler G, Sauerbrei W. The use of fractional polynomials to model continuous risk variables in epidemiology. Int J Epidemiol. 1999;28:964–974.PubMedCrossRef
18.
Sharp IK. Acetabular dysplasia: the acetabular angle. J Bone Joint Surg Br. 1961;43:268–272.
19.
Sibinski M, Synder M, Pruszczynski B. [Hip joint development after closed reduction complicated by growth disturbance of the capital femoral epiphysis][in Polish]. Chir Nazardow Ruchu Orto Pol. 2006;71:33–36.
20.
Skaggs DL, Kaminsky C, Tolo VT, Kay RM, Reynolds RA. Variability in measurement of acetabular index in normal and dysplastic hips, before and after reduction. J Pediatr Orthop. 1998;18:799–801.PubMed
21.
Spence G, Hocking R, Wedge JH, Roposch A. Effect of innominate and femoral varus derotation osteotomy on acetabular development in developmental dysplasia of the hip. J Bone Joint Surg Am. 2009;91:2622–2636.PubMedCrossRef
22.
Tönnis D. Normal values of the hip joint for evaluation of x-rays in children and adults. Clin Orthop Relat Res. 1976;119:39–47.PubMed
23.
Tönnis D. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. 1st ed. Berlin, Germany: Springer-Verlag; 1987.CrossRef
24.
Ucar DH, Isiklar ZU, Stanitski CL, Kandemir U, Tumer Y. Open reduction through a medial approach in developmental dislocation of the hip: a follow-up study to skeletal maturity. J Pediatr Orthop. 2004;24:493–500.PubMedCrossRef
25.
White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30:377–399.PubMedCrossRef
26.
Zeger SL, Liang KY, Albert PS. Models for longitudinal data: a generalized estimating equation approach. Biometrics. 1988;44:1049–1060.PubMedCrossRef
Metadata
Title
Osteonecrosis Complicating Developmental Dysplasia of the Hip Compromises Subsequent Acetabular Remodeling
Authors
Andreas Roposch, MD, MSc, FRCS
Deborah Ridout, MSc
Evangelia Protopapa, MSc
Nicholas Nicolaou, FRCS
Yael Gelfer, MD, PhD
Publication date
01-07-2013
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 7/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-013-2804-2

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