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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Association between the ossific nucleus and osteonecrosis in treating developmental dysplasia of the Hip: updated meta-analysis

Authors: Rafal Niziol, Michael Elvey, Evangelia Protopapa, Andreas Roposch

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

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Abstract

Background

A meta-analysis concluded that there was no effect of the femoral head ossification and the incidence of osteonecrosis in the treatment of developmental dysplasia of the hip (DDH), unless only osteonecrosis grades II-IV were considered. The meta-analysis, limited due to the small number of studies available at that time, identified a need for an update as further research emerges. We observed a trend in recent years towards delaying treatment of DDH in the absence of an ossified nucleus. Numerous new publications on this topic encouraged us to update the 2009 meta-analysis.

Methods

We performed a systematic review of the literature from 1967 to 2016 and included studies that reported on the treatment of DDH, the ossific nucleus and osteonecrosis. Two independent reviewers evaluated all articles. We performed a meta-analysis with the main outcome defined as the development of osteonecrosis of the femoral head at least two years after closed or open reduction.

Results

Of four prospective and ten retrospective studies included in the systematic review, 11 studies (1,021 hips) met the inclusion criteria for the meta-analysis. There was no significant effect of the ossific nucleus on the development of all grades of osteonecrosis (relative risk, 0.88; 95% confidence interval, 0.56–1.41) or osteonecrosis grades II–IV (0.67; 0.41–1.08). In closed reductions, the ossific nucleus halved the risk for developing osteonecrosis grades II–IV (0.50; 0.26–0.94).

Conclusions

Based on current evidence there does not appear to be a protective effect of the ossific nucleus on the development of osteonecrosis. In contrast to the previous meta-analysis, this update demonstrates that this remains the case irrespective of the grade of osteonecrosis considered relevant. This updated meta-analysis is based on twice as many studies with a higher quality of evidence.
Appendix
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Metadata
Title
Association between the ossific nucleus and osteonecrosis in treating developmental dysplasia of the Hip: updated meta-analysis
Authors
Rafal Niziol
Michael Elvey
Evangelia Protopapa
Andreas Roposch
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1468-6

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