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Avascular necrosis predictive factors after closed reduction in patients with developmental dysplasia of the hip
Sara Kheiri1, Mohammad Ali Tahririan1, Soheil Shahnaser1
1Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Older age and wider abduction angles increase avascular necrosis (AVN) risk in developmental dysplasia of the hip (DDH) patients after closed reduction (CR). Younger patients and lower abduction angles (under 54°) improve outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Hip Dysplasia Research
Background:
- Developmental dysplasia of the hip (DDH) is a prevalent pediatric orthopedic condition.
- Closed reduction (CR) is a common conservative treatment for DDH with high success rates.
- Avascular necrosis (AVN) is a significant complication following CR for DDH.
Purpose of the Study:
- To identify risk factors for AVN after CR and Spica cast immobilization in DDH patients.
- To determine the relationship between patient age, abduction angle, and AVN development.
Main Methods:
- Retrospective observational study of 71 patients (89 hips) with DDH aged 6-24 months.
- Follow-up for 3 years, documenting demographic data, Tönnis grade, pre-reduction procedures, and abduction angle.
- AVN presence classified using the Bucholz and Ogden criteria.
Main Results:
- 13 of 71 patients (18 hips) developed AVN.
- Older age (mean 14.3 vs 12.2 months) and lower abduction angle (51.86° vs 58.46°) were associated with AVN.
- Age over 12 months (OR=4.22) and abduction >54° (OR=34.88) significantly predicted AVN risk.
Conclusions:
- Older age at intervention and larger abduction angles in Spica casts are predictors of AVN post-CR for DDH.
- Performing CR at a younger age and maintaining abduction angles below 54° may improve prognosis.
Background:
Developmental dysplasia of the hip (DDH) is a common pediatric orthopedic condition. Closed reduction (CR) is the conservative treatment approach with high success rates for DDH. However, avascular necrosis (AVN) is a severe potential complication after this procedure. This study retrospectively assessed the potential risk factors for AVN occurrence after CR and Spica cast immobilization.
Materials And Methods:
In a retrospective observational study, 71 patients (89 hips) with DDH aged 6-24 months old undergoing CR were enrolled. All patients were followed up for 3 years, and their demographic data, initial Tönnis grade, pre-reduction procedures, abduction angle in the Spica cast, and the AVN presence (based on Bucholz and Ogden classification [3rd-4th class]) were documented.
Results:
Of 71 patients (89 hips) with a mean age of 12.5 ± 3.9 months, 13 patients (18 hips) developed AVN. The mean age of patients in the AVN and non-AVN groups was 14.3 ± 4.9 and 12.2 ± 3 months (P = 0.07); also, the mean abduction angle in patients with and without AVN was 51.86 ± 3.66 and 58.46 ± 3.91 (P < 0.001) in univariate analysis. The distribution of initial Tönnis grade, and previous conservative procedures, adductor tenotomies during the CR were comparable between the two groups (P > 0.05). We found age 12 months and 54° in abduction angle as the best cutoff values for differentiating AVN patients from non-AVN and the risk of experiencing AVN for patients older than 12 months was odds ratio (OR) =4.22 (P = 0.06) and patients with abduction angle greater than 54 was OR = 34.88 (P < 0.001).
Conclusion:
In this study, older age at the time of intervention and larger abduction angle in the hip Spica cast were two predictors of experiencing AVN in DDH patients after undergoing CR treatment approach. Performing CR at a younger age and keeping the abduction angle lower than 54° in the hip Spica cast could help to have the best possible prognosis.
Level Of Evidence:
IV, retrospective, observational, cross-sectional study.
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