Avascular necrosis after treatment of DDH: the protective influence of the ossific nucleus
L S Segal1, D K Boal, L Borthwick
1Department of Orthopaedics and Rehabilitation, The Milton S. Hershey Medical Center and The Pennsylvania State University College of Medicine, Hershey 17033, USA.
Insights
The presence of an ossific nucleus before hip reduction significantly reduces avascular necrosis (AVN) risk in developmental dysplasia of the hip (DDH) treatment. Early detection of this bone formation is key for better outcomes in infants.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Radiology
Background:
- Developmental dysplasia of the hip (DDH) is a common condition requiring timely intervention.
- Avascular necrosis (AVN) is a significant complication following hip reduction surgery in infants.
- Predicting and mitigating AVN risk remains a critical challenge in DDH management.
Purpose of the Study:
- To identify predictors of avascular necrosis (AVN) in infants undergoing reduction for developmental dysplasia of the hip (DDH).
- To evaluate the impact of pre-reduction ossific nucleus presence on AVN development after hip reduction procedures.
Main Methods:
- Retrospective review of 57 hip dislocations in 49 children younger than 12 months undergoing open or closed reduction.
- Analysis of AVN occurrence in relation to reduction method, pre-operative traction, Pavlik harness use, and age at intervention.
- Statistical evaluation of the presence of the ossific nucleus (detected by radiography or ultrasonography) as a predictor of AVN.
Main Results:
- No significant difference in AVN rates was found concerning traction, reduction type, Pavlik harness use, or age at intervention.
- The presence of an ossific nucleus before reduction was a highly significant predictor of lower AVN risk (p < 0.001 radiographically, p = 0.033 ultrasonographically).
- Only 4% of hips with a pre-reduction ossific nucleus developed AVN, compared to 53% of hips without it.
Conclusions:
- The presence of an ossific nucleus prior to hip reduction is a crucial factor in preventing avascular necrosis (AVN) in DDH treatment.
- Radiographic or ultrasonographic detection of the ossific nucleus can guide surgical decisions and improve outcomes for developmental dysplasia of the hip.
- This finding suggests a potential strategy to decrease AVN risk in infants with DDH.
Abstract:
We retrospectively reviewed the results of open or closed reduction for developmental dysplasia of the hip (DDH) in 49 children younger than 12 months old, who had 57 hip dislocations. Group A (18 hips) developed partial or complete avascular necrosis (AVN), and group B (39 hips) did not develop AVN. Thirty-eight hips were treated by closed reduction, and 17 had open reduction. One patient with bilateral hip dislocation initially had closed reductions followed by bilateral open reduction 3 months later. With the numbers available for study, there was no significant difference in the occurrence of AVN with respect to variables such as preliminary traction, closed versus open reduction, Pavlik harness use, and age at the time of operative intervention. However, the presence of the ossific nucleus before reduction, detected either by radiographs (p < 0.001) or ultrasonography (p = 0.033) was statistically significant in predicting AVN. Only one (4%) of 25 hips with an ossific nucleus developed AVN, whereas 17 (53%) of 32 hips without an ossific nucleus before reduction developed AVN. Our results suggest that the presence of the ossific nucleus before closed or open reduction for DDH may decrease the risk of AVN.
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