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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Main Authors: Rafal Niziol, Michael Elvey, Evangelia Protopapa, Andreas Roposch
Format: Article
Language:English
Published: BMC 2017-04-01
Series:BMC Musculoskeletal Disorders
Subjects:
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.
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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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AT evangeliaprotopapa associationbetweentheossificnucleusandosteonecrosisintreatingdevelopmentaldysplasiaofthehipupdatedmetaanalysis
AT andreasroposch associationbetweentheossificnucleusandosteonecrosisintreatingdevelopmentaldysplasiaofthehipupdatedmetaanalysis