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Tang Z, Li R, Lu C, Ma N, Xie R, Kang X, Chen X, Yang H, Hang Y, Li J, Zhou Y. Risk factors for avascular necrosis of the femoral head after developmental hip dislocation reduction surgery and construction of Nomogram prediction model. BMC Musculoskelet Disord 2024; 25:464. [PMID: 38877449 PMCID: PMC11179329 DOI: 10.1186/s12891-024-07575-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 06/07/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND To analyze the risk factors for the development of avascular necrosis (AVN) of the femoral head after reduction surgery in children with developmental hip dysplasia (DDH), and to establish a prediction nomogram. METHODS The clinical data of 134 children with DDH (169 hips) treated with closure reduction or open reduction from December 2016 to December 2019 were retrospectively analyzed. Independent risk factors for AVN after DDH reduction being combined with cast external immobilization were determined by univariate analysis and multivariate logistic regression and used to generate nomograms predicting the occurrence of AVN. RESULTS A total of 169 hip joints in 134 children met the inclusion criteria, with a mean age at surgery of 10.7 ± 4.56 months (range: 4-22 months) and a mean follow-up duration of 38.32 ± 27.00 months (range: 12-94 months). AVN developed in 42 hip joints (24.9%); univariate analysis showed that the International Hip Dysplasia Institute (IHDI) grade, preoperative development of the femoral head ossification nucleus, cartilage acetabular index, femoral head to acetabular Y-shaped cartilage distance, residual acetabular dysplasia, acetabular abduction angle exceeding 60°, and the final follow-up acetabular index (AI) were associated with the development of AVN (P < 0.05). Multivariate logistic regression analysis showed that the preoperative IHDI grade, development of the femoral head ossification nucleus, acetabular abduction angle exceeding 60°, and the final follow-up AI were independent risk factors for AVN development (P < 0.05). Internal validation of the Nomogram prediction model showed a consistency index of 0.833. CONCLUSION Preoperative IHDI grade, preoperative development of the femoral head ossification nucleus, final AI, and acetabular abduction angle exceeding 60° are risk factors for AVN development. This study successfully constructed a Nomogram prediction model for AVN after casting surgery for DDH that can predict the occurrence of AVN after casting surgery for DDH.
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Affiliation(s)
- Zidan Tang
- Graduate School, Kunming Medical University, Kunming, 650500, China
| | - Rong Li
- Department of Obstetric Ultrasound, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Chan Lu
- Graduate School, Kunming Medical University, Kunming, 650500, China
| | - Na Ma
- Graduate School, Kunming Medical University, Kunming, 650500, China
| | - Rui Xie
- Graduate School, Kunming Medical University, Kunming, 650500, China
| | - Xiaopeng Kang
- Department of Orthopedics, Kunming Children's Hospital, No. 288, Qianxing Road, Xishan District, Kunming, Yunnan, 650100, China
| | - Xinhao Chen
- Graduate School, Kunming Medical University, Kunming, 650500, China
| | - Han Yang
- Graduate School, Kunming Medical University, Kunming, 650500, China
| | - Yong Hang
- Department of Orthopedics, Kunming Children's Hospital, No. 288, Qianxing Road, Xishan District, Kunming, Yunnan, 650100, China
| | - Jun Li
- Department of Orthopedics, Kunming Children's Hospital, No. 288, Qianxing Road, Xishan District, Kunming, Yunnan, 650100, China
| | - You Zhou
- Department of Orthopedics, Kunming Children's Hospital, No. 288, Qianxing Road, Xishan District, Kunming, Yunnan, 650100, China.
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Cheon JE, Kim JY, Choi YH, Kim WS, Cho TJ, Yoo WJ. MRI risk factors for development of avascular necrosis after closed reduction of developmental dysplasia of the hip: Predictive value of contrast-enhanced MRI. PLoS One 2021; 16:e0248701. [PMID: 33735261 PMCID: PMC7971487 DOI: 10.1371/journal.pone.0248701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/03/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose The purpose of this study was to identify imaging risk factors on contrast-enhanced hip MRI after closed reduction of developmental dysplasia of the hip (DDH) that could predict future development of avascular necrosis (AVN) of the femoral head. Materials and methods Fifty-eight infants (F: M = 53: 5, aged 3–18 months) who underwent immediate postoperative contrast-enhanced hip MRI after closed reduction of DDH were included in this study. Quality of reduction (concentric vs eccentric reduction with or without obstacles), abduction angle of the hip, presence of ossific nucleus, and pattern of contrast enhancement of the femoral head were retrospectively evaluated on MRI. Interobserver agreement of contrast enhancement pattern on MRI were evaluated by two radiologists. Development of AVN was determined through radiographic findings at 1 year after reduction. Results AVN of the femoral head developed in 13 (22%) of 58 patients. Excessive abduction of the hip joint (OR 4.65, [95% CI 1.20, 18.06] and global decreased enhancement of the femoral head (OR 71.66, [95% CI 10.54, 487.31]) exhibited statistically significant differences between the AVN and non-AVN groups (P < 0.05). Eccentric reduction (P = 0.320) did not show statistically significant difference between two groups and invisible ossific nucleus (P = 0.05) showed borderline significance. Multi-variable logistic regression indicated that global decreased enhancement of the femoral head was a significant risk factor of AVN (OR 27.92, 95% CI [4.17, 350.18]) (P = 0.0031). Interobserver agreement of contrast enhancement pattern analysis and diagnosis of AVN were good (0.66, 95% CI [0.52, 0.80]). Conclusion Contrast-enhanced hip MRI provides accurate anatomical assessment of the hip after closed reduction of DDH. Global decreased enhancement of the femoral head could be used as a good predictor for future development of AVN after closed reduction of DDH.
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Affiliation(s)
- Jung-Eun Cheon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology and Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), Seoul National University Hospital, Seoul, Korea
- Division of Pediatric Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Ji Young Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology and Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), Seoul National University Hospital, Seoul, Korea
- Division of Pediatric Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology and Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), Seoul National University Hospital, Seoul, Korea
- Division of Pediatric Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology and Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), Seoul National University Hospital, Seoul, Korea
- Division of Pediatric Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Tae-Joon Cho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
- Division of Pediatric Orthopedics, Seoul National University Children’s Hospital, Seoul, Korea
| | - Won Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
- Division of Pediatric Orthopedics, Seoul National University Children’s Hospital, Seoul, Korea
- * E-mail:
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Developmental dysplasia of the hip: can contrast-enhanced MRI predict the development of avascular necrosis following surgery? Skeletal Radiol 2021; 50:389-397. [PMID: 32772128 DOI: 10.1007/s00256-020-03572-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the performance of contrast-enhanced MRI for predicting avascular necrosis (AVN) of the treated femoral head after surgical reduction for developmental dysplasia of the hip (DDH) using qualitative and quantitative methods. METHODS AND MATERIALS This IRB-approved, HIPAA compliant retrospective study included 47 children who underwent same-day contrast-enhanced MRI following unilateral surgical hip reduction between April 2009 and June 2018. Blinded to the clinical outcome, 3 reviewers (2 pediatric radiologists and 1 pediatric orthopedist) independently categorized the enhancement pattern of the treated femoral head. Signal intensities, measured using regions of interest (ROI), were compared between treated and untreated hips and percent enhancements were compared between hips that developed and did not develop AVN. Post-reduction radiographs were evaluated using Salter's criteria for AVN and Kalmachi and MacEwen's classification for growth disturbance. Non-parametric tests and Fisher exact test were used to compare enhancement values between AVN and non-AVN hips. Bonferroni correction was used for multiple comparisons. RESULTS Ten (21%) out of the 47 children (7 boys and 40 girls; mean age 9.0 ± 4.7 months) developed AVN. Age at surgical reduction was significantly higher (p = 0.03) for hips that developed AVN. No significant differences were found in gender (p = 0.61), laterality (p = 0.46), surgical approach (p = 0.08), history of pre-operative bracing (p = 0.72), abduction angle (p = 0.18-0.44), enhancement pattern (p = 0.66-0.76), or percent enhancement (p = 0.41-0.88) between AVN and non-AVN groups. CONCLUSION Neither enhancement pattern nor percent enhancement predicted AVN, suggesting that post-reduction conventional MRI does not accurately distinguish between reversible and permanent vascular injury.
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Barrera CA, Cohen SA, Sankar WN, Ho-Fung VM, Sze RW, Nguyen JC. Imaging of developmental dysplasia of the hip: ultrasound, radiography and magnetic resonance imaging. Pediatr Radiol 2019; 49:1652-1668. [PMID: 31686171 DOI: 10.1007/s00247-019-04504-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/26/2019] [Accepted: 08/07/2019] [Indexed: 01/16/2023]
Abstract
Developmental dysplasia of the hip (DDH) describes a broad spectrum of developmental abnormalities of the hip joint that are traditionally diagnosed during infancy. Because the development of the hip joint is a dynamic process, optimal treatment depends not only on the severity of the dysplasia, but also on the age of the child. Various imaging modalities are routinely used to confirm suspected diagnosis, to assess severity, and to monitor treatment response. For infants younger than 4 months, screening hip ultrasound (US) is recommended only for those with risk factors, equivocal or positive exam findings, whereas for infants older than 4-6 months, pelvis radiography is preferred. Following surgical hip reduction, magnetic resonance (MR) imaging is preferred over computed tomography (CT) because MR can not only confirm concentric hip joint reduction, but also identify the presence of soft-tissue barriers to reduction and any unexpected postoperative complications. The routine use of contrast-enhanced MR remains controversial because of the relative paucity of well-powered and validated literature. The main objectives of this article are to review the normal and abnormal developmental anatomy of the hip joint, to discuss the rationale behind the current recommendations on the most appropriate selection of imaging modalities for screening and diagnosis, and to review routine and uncommon findings that can be identified on post-reduction MR, using an evidence-based approach. A basic understanding of the physiology and the pathophysiology can help ensure the selection of optimal imaging modality and reduce equivocal diagnoses that can lead to unnecessary treatment.
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Affiliation(s)
- Christian A Barrera
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Sara A Cohen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Wudbhav N Sankar
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Victor M Ho-Fung
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Raymond W Sze
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA. .,Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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Liu YH, Xu HW, Li YQ, Hong K, Li JC, Pereira B, Xun FX, Canavese F. Effect of abduction on avascular necrosis of the femoral epiphysis in patients with late-detected developmental dysplasia of the hip treated by closed reduction: a MRI study of 59 hips. J Child Orthop 2019; 13:438-444. [PMID: 31695810 PMCID: PMC6808074 DOI: 10.1302/1863-2548.13.190045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to explore whether increasing the hip abduction angle would increase the incidence of avascular necrosis (AVN) in patients with late- detected developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization. METHODS A total of 55 patients (59 hips) with late-detected DDH underwent MRI after CR. Hip abduction angle and hip joint distance were measured on postoperative MRI transverse sections. The acetabular index and centre-edge angle were measured on plain radiographs at the last follow-up. The presence of AVN according to Kalamchi and McEwen's classification was assessed. We retrospectively analyzed the associations among abduction angles, hip joint distances, radiographic parameters, AVN and final outcomes, exploring the relationship between hip joint abduction angle and AVN rate. RESULTS The mean age at the time of CR was 14.4 months SD 5.5 (6 to 28), and the mean follow-up was 26.2 months SD 8.1 (12.4 to 41.7). The mean hip abduction angle was 70.2° SD 7.2° (53° to 85°) on the dislocated side and 63.7° SD 8.8° (40° to 82°) on the normal side; the mean hip joint distance was 5.1 mm SD 1.9 (1.3 to 9.1) on the dislocated side and 2.2 mm SD 0.6 on the normal side (1.3 to 3.3). Eight of 59 hips (13.6%) developed AVN. Neither the amount of abduction nor hip joint distance increased the AVN rate (p = 0.97 and p = 0.65, respectively) or the dislocation rate (p = 0.38 and p = 0.14, respectively). CONCLUSION Abduction angle up to 70.2° following CR did not increase the AVN rate in children aged six to 28 months with late-detected DDH treated by CR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Y. H. Liu
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - H. W. Xu
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - Y. Q. Li
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - K. Hong
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - J. C. Li
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - B. Pereira
- Department of Pediatric Orthopedic Surgery, University Hospital Estaing, Clermont Ferrand, France
| | - F. X. Xun
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China
| | - F. Canavese
- Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, Guangzhou, China,Department of Pediatric Orthopedic Surgery, University Hospital Estaing, Clermont Ferrand, France,Correspondence should be sent to F. Canavese, Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, 9th Jingshui Rd. Guangzhou, 510623, China. E-mail:
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