Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2021

01-12-2021 | Hip Dysplasia | Research article

Patient-reported outcomes in young adults with osteonecrosis secondary to developmental dysplasia of the hip - a longitudinal and cross-sectional evaluation

Authors: Avi Marks, Mario Cortina-Borja, Dror Maor, Aresh Hashemi-Nejad, Andreas Roposch

Published in: BMC Musculoskeletal Disorders | Issue 1/2021

Login to get access

Abstract

Background

Osteonecrosis of the femoral head is a common complication in the treatment of developmental dysplasia of the hip (DDH). While functional outcomes of affected patients are good in childhood, it is not clear how they change during the transition to young adulthood. This study determined the relationship between osteonecrosis and hip function, physical function and health status in adolescents and young adults.

Methods

We performed a cross-sectional study of 169 patients with a mean age of 19.7 ± 3.8 years with and without osteonecrosis following an open or closed reduction (1995–2005). We also performed a separate longitudinal evaluation of an historical cohort of 54 patients with osteonecrosis, embedded in this sample. All completed patient-reported outcome measures in 2015/2016 to quantify hip function (maximum score 100); physical function (maximum score 100); and general health status (maximum score 1). We graded all radiographs for subtype of osteonecrosis (Bucholz-Ogden); acetabular dysplasia (centre-edge angle); subluxation (Shenton’s line); and osteoarthritis (Kellgren-Lawrence). Analyses were adjusted for the number of previous surgical procedures on the hip and for the severity of residual hip dysplasia.

Results

In 149 patients (186 hips) with and without osteonecrosis, the mean differences (95% confidence interval) in hip function, physical function and quality of life were − 4.7 (− 10.26, 0.81), − 1.03 (− 9.29, 7.23) and 0.10 (− 1.15, 1.18), respectively. Adjusted analyses stratified across types of osteonecrosis showed that only patients with Bucholz-Odgen grade III had reduced hip function (p < 0.01) and physical function (p < 0.05) but no difference in health-related quality of life when compared to no osteonecrosis.

Conclusion

Osteonecrosis secondary to DDH is a relatively benign disorder in adolescents and young adulthood. Affected patients demonstrated minimal physical disability, a normal quality of life but reduced hip function.
Literature
1.
Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1980;62:876–88.PubMedCrossRef
2.
Roposch A, Ridout D, Protopapa E, Nicolaou N, Gelfer Y. Osteonecrosis complicating developmental dysplasia of the hip compromises subsequent acetabular remodeling. Clin Orthop Relat Res. 2013;471:2318–26.PubMedPubMedCentralCrossRef
3.
Tang HC, Lee WC, Kao HK, Yang WE, Chang CH. Surgical outcomes of developmental dysplasia of the hip with or without prior failed closed reduction. J Pediatr Orthop. 2015;35:703–7.PubMedCrossRef
4.
Salter RB, Kostuik J, Dallas S. Avascular necrosis of the femoral head as a complication of treatment for congenital dislocation of the hip in young children: a clinical and experimental investigation. Can J Surg. 1969;12:44–61.PubMed
5.
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;72:557–62.PubMedCrossRef
6.
Cooperman DR, Wallensten R, Stulberg SD. Post-reduction avascular necrosis in congenital dislocation of the hip. J Bone Joint Surg Am. 1980;62:247–58.PubMedCrossRef
7.
8.
Wenger DR, Lee CS, Kolman B. Derotational femoral shortening for developmental dislocation of the hip: special indications and results in the child younger than 2 years. J Pediatr Orthop. 1995;15:768–79.PubMedCrossRef
9.
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;76:1777–92.PubMedCrossRef
10.
Thomas IH, Dunin AJ, Cole WG, Menelaus MB. Avascular necrosis after open reduction for congenital dislocation of the hip: analysis of causative factors and natural history. J Pediatr Orthop. 1989;9:525–31.PubMedCrossRef
11.
Bucholz RWOJ. Patterns of ischemic necrosis of the proximal femur in nonoperatively treated congenital hip disease. St Louis, MO: The Hip: Proceedings of the Sixth Open Scientific Meeting of the Hip Society; 1978. p. 43–63.
12.
Roposch A, Liu LQ, Offiah AC, Wedge JH. Functional outcomes in children with osteonecrosis secondary to treatment of developmental dysplasia of the hip. J Bone Joint Surg Am. 2011;93:e145.PubMedCrossRef
13.
Troelsen A, Jacobsen S, Romer L, Soballe K. Weightbearing anteroposterior pelvic radiographs are recommended in DDH assessment. Clin Orthop Relat Res. 2008;466:813–9.PubMedPubMedCentralCrossRef
14.
15.
Sharp IK. Acetabular dysplasia - the Acetabular angle. J Bone Joint Surg Am. 1961;43:268–72.CrossRef
16.
17.
Landis JR, Koch GG. Measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.PubMedCrossRef
18.
Aguilar CM, Neumayr LD, Eggleston BE, et al. Clinical evaluation of avascular necrosis in patients with sickle cell disease: Children’s hospital Oakland hip evaluation scale--a modification of the Harris hip score. Arch Phys Med Rehabil. 2005;86:1369–75.PubMedCrossRef
19.
20.
Young NL, Williams JI, Yoshida KK, Wright JG. Measurement properties of the activities scale for kids. J Clin Epidemiol. 2000;53:125–37.PubMedCrossRef
21.
Davis AM, Perruccio AV, Canizares M, et al. Comparative, validity and responsiveness of the HOOS-PS and KOOS-PS to the WOMAC physical function subscale in total joint replacement for osteoarthritis. Osteoarthr Cartil. 2009;17:843–7.CrossRef
22.
Davis AM, Perruccio AV, Canizares M, et al. The development of a short measure of physical function for hip OA HOOS-physical function Shortform (HOOS-PS): an OARSI/OMERACT initiative. Osteoarthr Cartil. 2008;16:551–9.CrossRef
23.
Horsman J, Furlong W, Feeny D, Torrance G. The health utilities index (HUI): concepts, measurement properties and applications. Health Qual Life Outcomes. 2003;1:54.PubMedPubMedCentralCrossRef
24.
Feeny D, Furlong W, Boyle M, Torrance GW. Multi-attribute health status classification systems. Health Utilities Index Pharmacoeconomics. 1995;7:490–502.PubMed
25.
Naglie G, Krahn MD, Naimark D, Redelmeier DA, Detsky AS. Primer on medical decision analysis: part 3--estimating probabilities and utilities. Med Decis Mak. 1997;17:136–41.CrossRef
26.
Hox JJ. Multilevel analysis: techniques and applications. 2nd edition ed. New York, NY: Routledge; 2010.CrossRef
27.
McWilliams DF, Doherty SA, Jenkins WD, et al. Mild acetabular dysplasia and risk of osteoarthritis of the hip: a case-control study. Ann Rheum Dis. 2010;69:1774–8.PubMedCrossRef
28.
Harrell FE. Regression modeling strategies : with applications to linear models, logistic regression, and survival analysis. New York. London: Springer; 2001.CrossRef
29.
Akaike H. New Look at Statistical-Model Identification. Ieee Transactions on Automatic Control. 1974;Ac19:716–23.CrossRef
30.
Cohen J. Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull. 1968;70:213–20.PubMedCrossRef
31.
Shrout PE, Fleiss JL. Intraclass correlations - uses in assessing rater reliability. Psychol Bull. 1979;86:420–8.CrossRefPubMed
32.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. ed. Hillsdale, N.J.: L. Erlbaum Associates; 1988.
33.
Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–87.PubMedCrossRef
34.
35.
Weinstein SL. Bristol-Myers Squibb/Zimmer award for distinguished achievement in orthopaedic research. Long-term follow-up of pediatric orthopaedic conditions. Natural history and outcomes of treatment. J Bone Joint Surg Am. 2000;82-A(7):980–90.PubMedCrossRef
36.
Bar-On E, Huo MH, DeLuca PA. Early innominate osteotomy as a treatment for avascular necrosis complicating developmental hip dysplasia. J Pediatr Orthop. 1997;6(2):138–45.CrossRef
37.
Okano K, Yamada K, Takahashi K, Enomoto H, Osaki M, Shindo H. Long-term outcome of Ludloff's medial approach for open reduction of developmental dislocation of the hip in relation to the age at operation. Int Orthop. 2009;33(5):1391–6.PubMedPubMedCentralCrossRef
38.
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(5):493–500.PubMedCrossRef
39.
Koizumi W, Moriya H, Tsuchiya K, Takeuchi T, Kamegaya M, Akita T. Ludloff's medial approach for open reduction of congenital dislocation of the hip. A 20-year follow-up. J Bone Joint Surg Br. 1996;78(6):924–9.PubMedCrossRef
40.
Engesaeter IO, Lehmann T, Laborie LB, Lie SA, Rosendahl K, Engesaeter LB. Total hip replacement in young adults with hip dysplasia: age at diagnosis, previous treatment, quality of life, and validation of diagnoses reported to the Norwegian Arthroplasty register between 1987 and 2007. Acta Orthop. 2011;82(2):149–54.PubMedPubMedCentralCrossRef
41.
Wedge JH, Wasylenko MJ, Houston CS. Minor anatomic abnormalities of the hip joint persisting from childhood and their possible relationship to idiopathic osteoarthrosis. CORR. 1991;264:122–8.
42.
Plint AC, Gaboury I, Owen J, Young NL. Activities scale for kids: an analysis of normals. J Pediatr Orthop. 2003;23:788–90.PubMedCrossRef
43.
Cooperman D. What is the evidence to support acetabular dysplasia as a cause of osteoarthritis? J Pediatr Orthop. 2013;33(Suppl 1):S2–7.PubMedCrossRef
44.
Eagar K, Green J, Gordon R, Owen A, Masso M, Williams K. Functional assessment to predict capacity for work in a population of school-leavers with disabilities. Int J of Disabil, Dev Ed. 2006;53:331–49.CrossRef
45.
Bagley AM, Gorton GE, Bjornson K, et al. Factor- and item-level analyses of the 38-item activities scale for kids-performance. Dev Med Child Neurol. 2011;53:161–6.PubMedCrossRef
46.
Gibson PH, Benson MK. Congenital dislocation of the hip. Review at maturity of 147 hips treated by excision of the limbus and derotation osteotomy. J Bone Joint Surg Br. 1982;64:169–75.PubMedCrossRef
Metadata
Title
Patient-reported outcomes in young adults with osteonecrosis secondary to developmental dysplasia of the hip - a longitudinal and cross-sectional evaluation
Authors
Avi Marks
Mario Cortina-Borja
Dror Maor
Aresh Hashemi-Nejad
Andreas Roposch
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2021
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-020-03865-3

Other articles of this Issue 1/2021

BMC Musculoskeletal Disorders 1/2021 Go to the issue

Research article

Intraoperative three-dimensional imaging in ankle syndesmotic reduction

Research article

Despite higher revision rate, MoM large-head THA offers better clinical scores than HR: 14-year results from a randomized controlled trial involving 48 patients

Research

Intralesional nerve-sparing surgery versus non-surgical treatment for giant cell tumor of the sacrum

Research article

Pentosan polysulfate sodium for Ross River virus-induced arthralgia: a phase 2a, randomized, double-blind, placebo-controlled study

Research

Incidence and underreporting of osseous wrist and hand injuries on whole-body computed tomographies at a level 1 trauma center

Research

Responsiveness of the EuroQoL 5-Dimension (EQ-5D) questionnaire in patients with spondyloarthritis