Mahapatra S K, Hampannavar A, Choudhury S, Gourineni V, Sahu B, Rout J
Acta Orthop Belg. 2024 Sep;90(3):535-542. doi: 10.52628/90.3.12274.
Avascular necrosis (AVN) is a known complication during the management of developmental dysplasia of the hip (DDH). It has the potential to alter the growth of the head or acetabulum and prevent the best outcomes. While past literature has evaluated the risks of AVN and strategies to avoid it, studies on the impact of AVN on the outcomes are scarce. In this systematic review, we aim to study the extent of the effects of AVN on the outcomes, in the management of DDH. In this systematic review series for 1990 to 2021 were pooled. The clinical and radiological outcomes of the AVN and non-AVN groups were compared. The effects of other modifying factors were also evaluated. A total of 170 AVN and 585 non-AVN hips from 21 papers were compared. The analysis did not show any statistically significant difference between the AVN and non-AVN groups in terms of clinical or radiological parameters. Interestingly patients who had the index surgery at a younger age had a higher risk of further surgery, with acetabular osteotomy being the most common secondary procedure. The negative impact of AVN may not be as severe as previously thought. Thus, the fear of AVN should not take precedence over the primary goal of DDH management i.e. obtaining a stable concentric mobile hip.
股骨头缺血性坏死（AVN）是发育性髋关节发育不良（DDH）治疗过程中一种已知的并发症。它有可能改变股骨头或髋臼的生长，并妨碍获得最佳治疗效果。尽管过去的文献已经评估了AVN的风险以及避免其发生的策略，但关于AVN对治疗结果影响的研究却很少。在这项系统评价中，我们旨在研究AVN在DDH治疗中对治疗结果的影响程度。对1990年至2021年的该系列系统评价进行汇总。比较了AVN组和非AVN组的临床和放射学结果。还评估了其他修正因素的影响。对来自21篇论文的总共170例AVN髋关节和585例非AVN髋关节进行了比较。分析显示，AVN组和非AVN组在临床或放射学参数方面没有任何统计学上的显著差异。有趣的是，年龄较小接受初次手术的患者再次手术的风险较高，髋臼截骨术是最常见的二次手术。AVN的负面影响可能没有之前认为的那么严重。因此,对AVN的担忧不应优先于DDH治疗的首要目标，即获得一个稳定的同心活动髋关节。
