Association between the ossific nucleus and osteonecrosis in treating developmental dysplasia of the Hip: updated meta-analysis
Abstract Background A meta-analysis concluded that there was no effect of the femoral head ossification and the incidence of osteonecrosis in the treatment of developmental dysplasia of the hip (DDH), unless only osteonecrosis grades II-IV were considered. The meta-analysis, limited due to the small...
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Format: | Article |
Language: | English |
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BMC
2017-04-01
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Series: | BMC Musculoskeletal Disorders |
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Online Access: | http://link.springer.com/article/10.1186/s12891-017-1468-6 |
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author | Rafal Niziol Michael Elvey Evangelia Protopapa Andreas Roposch |
author_facet | Rafal Niziol Michael Elvey Evangelia Protopapa Andreas Roposch |
author_sort | Rafal Niziol |
collection | DOAJ |
description | Abstract Background A meta-analysis concluded that there was no effect of the femoral head ossification and the incidence of osteonecrosis in the treatment of developmental dysplasia of the hip (DDH), unless only osteonecrosis grades II-IV were considered. The meta-analysis, limited due to the small number of studies available at that time, identified a need for an update as further research emerges. We observed a trend in recent years towards delaying treatment of DDH in the absence of an ossified nucleus. Numerous new publications on this topic encouraged us to update the 2009 meta-analysis. Methods We performed a systematic review of the literature from 1967 to 2016 and included studies that reported on the treatment of DDH, the ossific nucleus and osteonecrosis. Two independent reviewers evaluated all articles. We performed a meta-analysis with the main outcome defined as the development of osteonecrosis of the femoral head at least two years after closed or open reduction. Results Of four prospective and ten retrospective studies included in the systematic review, 11 studies (1,021 hips) met the inclusion criteria for the meta-analysis. There was no significant effect of the ossific nucleus on the development of all grades of osteonecrosis (relative risk, 0.88; 95% confidence interval, 0.56–1.41) or osteonecrosis grades II–IV (0.67; 0.41–1.08). In closed reductions, the ossific nucleus halved the risk for developing osteonecrosis grades II–IV (0.50; 0.26–0.94). Conclusions Based on current evidence there does not appear to be a protective effect of the ossific nucleus on the development of osteonecrosis. In contrast to the previous meta-analysis, this update demonstrates that this remains the case irrespective of the grade of osteonecrosis considered relevant. This updated meta-analysis is based on twice as many studies with a higher quality of evidence. |
first_indexed | 2024-04-13T12:27:44Z |
format | Article |
id | doaj.art-25e82b81937845b7b9a7c062335b3d1c |
institution | Directory Open Access Journal |
issn | 1471-2474 |
language | English |
last_indexed | 2024-04-13T12:27:44Z |
publishDate | 2017-04-01 |
publisher | BMC |
record_format | Article |
series | BMC Musculoskeletal Disorders |
spelling | doaj.art-25e82b81937845b7b9a7c062335b3d1c2022-12-22T02:46:58ZengBMCBMC Musculoskeletal Disorders1471-24742017-04-011811910.1186/s12891-017-1468-6Association between the ossific nucleus and osteonecrosis in treating developmental dysplasia of the Hip: updated meta-analysisRafal Niziol0Michael Elvey1Evangelia Protopapa2Andreas Roposch3Great Ormond Street Hospital for Children and UCL Institute of Child HealthGreat Ormond Street Hospital for Children and UCL Institute of Child HealthGreat Ormond Street Hospital for Children and UCL Institute of Child HealthGreat Ormond Street Hospital for Children and UCL Institute of Child HealthAbstract Background A meta-analysis concluded that there was no effect of the femoral head ossification and the incidence of osteonecrosis in the treatment of developmental dysplasia of the hip (DDH), unless only osteonecrosis grades II-IV were considered. The meta-analysis, limited due to the small number of studies available at that time, identified a need for an update as further research emerges. We observed a trend in recent years towards delaying treatment of DDH in the absence of an ossified nucleus. Numerous new publications on this topic encouraged us to update the 2009 meta-analysis. Methods We performed a systematic review of the literature from 1967 to 2016 and included studies that reported on the treatment of DDH, the ossific nucleus and osteonecrosis. Two independent reviewers evaluated all articles. We performed a meta-analysis with the main outcome defined as the development of osteonecrosis of the femoral head at least two years after closed or open reduction. Results Of four prospective and ten retrospective studies included in the systematic review, 11 studies (1,021 hips) met the inclusion criteria for the meta-analysis. There was no significant effect of the ossific nucleus on the development of all grades of osteonecrosis (relative risk, 0.88; 95% confidence interval, 0.56–1.41) or osteonecrosis grades II–IV (0.67; 0.41–1.08). In closed reductions, the ossific nucleus halved the risk for developing osteonecrosis grades II–IV (0.50; 0.26–0.94). Conclusions Based on current evidence there does not appear to be a protective effect of the ossific nucleus on the development of osteonecrosis. In contrast to the previous meta-analysis, this update demonstrates that this remains the case irrespective of the grade of osteonecrosis considered relevant. This updated meta-analysis is based on twice as many studies with a higher quality of evidence.http://link.springer.com/article/10.1186/s12891-017-1468-6Femoral HeadOsteonecrosisOpen ReductionSeptic ArthritisClosed Reduction |
spellingShingle | Rafal Niziol Michael Elvey Evangelia Protopapa Andreas Roposch Association between the ossific nucleus and osteonecrosis in treating developmental dysplasia of the Hip: updated meta-analysis BMC Musculoskeletal Disorders Femoral Head Osteonecrosis Open Reduction Septic Arthritis Closed Reduction |
title | Association between the ossific nucleus and osteonecrosis in treating developmental dysplasia of the Hip: updated meta-analysis |
title_full | Association between the ossific nucleus and osteonecrosis in treating developmental dysplasia of the Hip: updated meta-analysis |
title_fullStr | Association between the ossific nucleus and osteonecrosis in treating developmental dysplasia of the Hip: updated meta-analysis |
title_full_unstemmed | Association between the ossific nucleus and osteonecrosis in treating developmental dysplasia of the Hip: updated meta-analysis |
title_short | Association between the ossific nucleus and osteonecrosis in treating developmental dysplasia of the Hip: updated meta-analysis |
title_sort | association between the ossific nucleus and osteonecrosis in treating developmental dysplasia of the hip updated meta analysis |
topic | Femoral Head Osteonecrosis Open Reduction Septic Arthritis Closed Reduction |
url | http://link.springer.com/article/10.1186/s12891-017-1468-6 |
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