Assessing Avascular Necrosis Risk and Outcomes After Open Reduction for Developmental Dysplasia of the Hip in
Mohamed Zamzam1, Khalid A Bakarman1, Abdulrahman A Alaujan2
1Orthopedics, King Saud University, Riyadh, SAU.
Insights
Avascular necrosis (AVN) of the femoral head is a complication of hip dysplasia surgery. Key risk factors for AVN include previous reduction attempts and prolonged casting, impacting patient outcomes.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Radiology
Background:
- Avascular necrosis (AVN) of the femoral head is a significant complication following surgical treatment for developmental dysplasia of the hip (DDH).
- Understanding AVN incidence and risk factors is crucial for improving surgical outcomes in DDH patients.
Purpose of the Study:
- To determine the incidence of AVN after surgical DDH treatment.
- To identify risk factors associated with AVN development.
- To evaluate the impact of AVN and other factors on clinical and radiological outcomes.
Main Methods:
- Retrospective analysis of 131 patients (189 hips) treated for DDH according to a specific protocol.
- Clinical and radiological evaluations at 6, 12 months, and final follow-up.
- Multivariate regression analysis to identify significant determinants of AVN and outcomes.
Main Results:
- AVN occurred postoperatively in 23 (12%) hips.
- AVN, prolonged casting, and repeat surgery were linked to poor clinical outcomes.
- AVN, prior closed reduction attempts, and repeat surgery correlated with worse radiological outcomes.
- Risk factors for AVN included prior closed reduction, absence of ossified femoral head, prolonged casting, and repeat surgery.
Conclusions:
- Identified key factors contributing to AVN after open reduction for DDH.
- Highlighted determinants of unsatisfactory clinical and radiological outcomes.
- Emphasized the necessity of addressing these factors to enhance treatment results.
Abstract:
Background Avascular necrosis (AVN) of the femoral head is a serious complication after surgical treatment of developmental dysplasia of the hip (DDH). The main objective of this study is to identify the incidence of AVN and to define AVN risk factors. The study also aims to identify the effects of AVN and other factors on final clinical and radiological outcomes. Methods All patients in the study were managed according to King Saud University protocol for surgical treatment of DDH. Occurrence of AVN was reported. All affected hips were evaluated clinically and radiologically after six and 12 months and at final follow-up. Significant variables from the univariate analysis were entered into multivariate regression models. Results A total of 131 patients were included in the study involving 189 hips with DDH. AVN was diagnosed postoperatively in 23 (12%) hips. In the multivariate regression analysis, the presence of AVN (p=0.002), prolonged casting (p=0.016) and the need for a second surgery (p=0.029) were strong determinants of unsatisfactory clinical outcomes. Worse radiological outcomes were significantly associated with the presence of AVN (p=0.002), previous trials of closed reduction (p=0.032) and the need for a second surgery (p=0.013). In the last multivariate regression model, a previous trial of closed reduction (p=0.001), absence of an ossified femoral head (OFH) (p=< 0.001), prolonged casting (p=0.038), and the need for second surgery (p=0) were strong risk factors for AVN. Conclusions The current study highlighted the factors responsible for AVN occurrence after open DDH reduction. The factors which are strong determinants of unsatisfactory clinical and radiological outcomes were identified. Overcoming these factors is mandatory to improve the results.
