CORR Insights(®): Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis.

Abstract

T he study by Novais and colleagues examines two hotly debated questions: Are older patients with developmental dysplasia of the hip (DDH) at greater risk for osteonecrosis when undergoing closed or open reduction, and does the surgical approach influence this risk? Traditional teaching on these topics is rooted as much in dogma as science, and most practicing clinicians likely follow the beliefs of their training programs. I believe that for hips undergoing open reduction, achieving concentric reduction with a stable hip and avoiding osteonecrosis likely are the main factors in accomplishing the best longterm hip function and radiographic results. Open reduction for hip dysplasia can be indicated in patients where there has been either a failure of early management or failure of hip screening (resulting in late detection). Sometimes open reduction is delayed until bone in the femoral head can be seen in a radiograph. There is a possibility that the hip is too fragile before this bone appears and that closed reduction may impair the growth of the hip. On the other hand, delaying this procedure until the child is older may result in stiffness and more abnormality of the hip joint, reducing the effects of treatment. Researchers cannot agree on whether waiting for this bone to appear helps protect the hip from damage during reduction. There is no way to know if damage to the blood supply of the hip or damage to the growth plate has occurred for at least 6 months after the closed reduction since one has to wait for the radiographic capital epiphysis to appear and monitor its growth to identify these findings. Surgical approach remains a matter of training and personal preference. Proponents of either approach (medial or anterior) purportedly have strong This CORR Insights is a commentary on the article ‘‘Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis’’ by Novais and colleagues available at: DOI: 10.1007/s11999-0154590-5. The author certifies that he, or any member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI: 10.1007/s11999-0154590-5. H. Hosalkar MD, MBMS (Orth), FCPS (Orth), DNB (Orth), FACS Paradise Valley Hospital, Tri-city Medical Center, Scripps and Sharp Health System, San Diego, CA, USA