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. Cite this article:
