Medial open reduction for developmental dysplasia of the hip was associated with a 20% rate of clinically significant avascular necrosis, leading to more unsatisfactory outcomes (55% vs 20%; P<0.001).
Systematic Review (n=734)
What is the incidence of avascular necrosis following medial open reduction in children with developmental dysplasia of the hip?
Medial open reduction for DDH carries a 20% risk of clinically significant AVN, which is increased by surgery before 12 months of age and post-operative abduction ≥60°.
The incidence of clinically significant avascular necrosis (AVN) following medial open reduction of the dislocated hip in children with developmental dysplasia of the hip (DDH) remains unknown. We performed a systematic review of the literature to identify all clinical studies reporting the results of medial open reduction surgery. A total of 14 papers reporting 734 hips met the inclusion criteria. The mean follow-up was 10.9 years (2 to 28). The rate of clinically significant AVN (types 2 to 4) was 20% (149/734). From these papers 221 hips in 174 children had sufficient information to permit more detailed analysis. The rate of AVN increased with the length of follow-up to 24% at skeletal maturity, with type 2 AVN predominating in hips after five years' follow-up. The presence of AVN resulted in a higher incidence of an unsatisfactory outcome at skeletal maturity (55% vs 20% in hips with no AVN; p < 0.001). A higher rate of AVN was identified when surgery was performed in children aged < 12 months, and when hips were immobilised in ≥ 60° of abduction post-operatively. Multivariate analysis showed that younger age at operation, need for further surgery and post-operative hip abduction of ≥ 60° increased the risk of the development of clinically significant AVN.
Gardner et al. (Sat,) conducted a systematic review in developmental dysplasia of the hip (DDH) (n=734). Medial open reduction was evaluated on Clinically significant avascular necrosis (AVN) (types 2 to 4). Medial open reduction for developmental dysplasia of the hip was associated with a 20% rate of clinically significant avascular necrosis, leading to more unsatisfactory outcomes (55% vs 20%; P<0.001).