Proximal Femoral Growth Alterations Can Be Seen Prior to Treatment of Developmental Dysplasia of the Hip: A Multicenter Cohort Study

Background: Avascular necrosis (AVN), better considered proximal femoral growth disturbance (PFGD), following treatment for developmental dysplasia of the hip (DDH) remains poorly defined. In addition to limited reliability, it has been our experience that some radiographic features attributed AVN/PFGD may be present prior surgery. Our purpose was determine baseline prevalence suggestive PFGD in a diverse population with surgically-treated DDH. Methods: The prospectively collected database an international multicenter study group retrospectively queried patients undergoing surgery DDH minimum one-year and clinical follow-up. Preoperative radiographs were evaluated findings typically used define at Development actual determined by consensus review follow-up three experts separate from this study. Results: 145 evaluated, median preoperative age 16.8 months (IQR:10.7-25.60). proportion initial IHDI grades 2, 3, or 4 18%, 32%, 50%, respectively. Prior surgery, 20 hips (14%) had heterogenous “fragmented” epiphysis. Eight epiphyses (6%) significantly ellipsoid shape. Depending on definition, between 5-10% wider neck compared contralateral, normal hip. At final follow-up, 42% have based review. Of all 59% one feature baseline, 20% two more. Conclusions: current suggests several factors development surgical intervention. data demonstrates who develop AVN least markers PFGD, per Salter criteria, receiving any treatment. This these not morphologically “normal” adds mounting body evidence about limitations classification AVN.