Functional Outcomes in Children with Osteonecrosis Secondary to Treatment of Developmental Dysplasia of the Hip
BACKGROUND:Osteonecrosis of the femoral head is a major potential complication following the treatment of developmental dysplasia of the hip. It remains unclear if the radiographic changes associated with osteonecrosis are clinically relevant. METHODS:In the present cross-sectional study, we determi...
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description | BACKGROUND:Osteonecrosis of the femoral head is a major potential complication following the treatment of developmental dysplasia of the hip. It remains unclear if the radiographic changes associated with osteonecrosis are clinically relevant.
METHODS:In the present cross-sectional study, we determined the relationship between morphological changes on radiographs (classified with use of the Bucholz-Ogden system) and health-related quality of life (assessed with the Health Utilities Index Mark 3 [HUI3]; maximum score, 1), physical function (assessed with the Activities Scale for Kids [ASK]; maximum score, 100), and hip function (assessed with the Childrenʼs Hospital Oakland Hip Evaluation Scale [CHOHES]; maximum score, 100). The study group included seventy-two children (mean age, 14 ± 2.5 years) with a diagnosis of osteonecrosis of the hip secondary to the treatment of developmental dysplasia of the hip. Patient assessments were standardized (intraclass correlation coefficient, ≥0.93). Radiographs were graded by three experts according to consensus. Analyses were adjusted for the number of previous surgical procedures on the hip and for the severity of residual hip dysplasia.
RESULTS:The median ASK score was 97 (interquartile range, 93 to 100), the median CHOHES score was 86 (interquartile range, 77 to 96), and the median HUI3 score was 1 (interquartile range, 0.9 to 1). The ASK summary scores were nearly equal (median, >90) across all radiographic grades. Adjusted mean scores showed a downward shift with worse radiographic grades. The ASK scores (p = 0.004) and CHOHES scores (p = 0.006) differed across radiographic grades, with Bucholz-Ogden grade-I and II hips demonstrating significantly better scores than grade-III and IV hips.
DISCUSSION:Osteonecrosis secondary to the treatment of developmental dysplasia of the hip is a relatively benign condition in children and teenagers. While it was associated with limited hip function, it was not associated with physical disability. However, we speculate that this function will decline with increasing age. With regard to clinical outcome, Bucholz-Ogden grade-I hips are similar to grade-II hips and grade-III hips are similar to grade-IV hips.
LEVEL OF EVIDENCE:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. |
doi_str_mv | 10.2106/JBJS.J.01623 |
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METHODS:In the present cross-sectional study, we determined the relationship between morphological changes on radiographs (classified with use of the Bucholz-Ogden system) and health-related quality of life (assessed with the Health Utilities Index Mark 3 [HUI3]; maximum score, 1), physical function (assessed with the Activities Scale for Kids [ASK]; maximum score, 100), and hip function (assessed with the Childrenʼs Hospital Oakland Hip Evaluation Scale [CHOHES]; maximum score, 100). The study group included seventy-two children (mean age, 14 ± 2.5 years) with a diagnosis of osteonecrosis of the hip secondary to the treatment of developmental dysplasia of the hip. Patient assessments were standardized (intraclass correlation coefficient, ≥0.93). Radiographs were graded by three experts according to consensus. Analyses were adjusted for the number of previous surgical procedures on the hip and for the severity of residual hip dysplasia.
RESULTS:The median ASK score was 97 (interquartile range, 93 to 100), the median CHOHES score was 86 (interquartile range, 77 to 96), and the median HUI3 score was 1 (interquartile range, 0.9 to 1). The ASK summary scores were nearly equal (median, >90) across all radiographic grades. Adjusted mean scores showed a downward shift with worse radiographic grades. The ASK scores (p = 0.004) and CHOHES scores (p = 0.006) differed across radiographic grades, with Bucholz-Ogden grade-I and II hips demonstrating significantly better scores than grade-III and IV hips.
DISCUSSION:Osteonecrosis secondary to the treatment of developmental dysplasia of the hip is a relatively benign condition in children and teenagers. While it was associated with limited hip function, it was not associated with physical disability. However, we speculate that this function will decline with increasing age. With regard to clinical outcome, Bucholz-Ogden grade-I hips are similar to grade-II hips and grade-III hips are similar to grade-IV hips.
LEVEL OF EVIDENCE:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.</description><identifier>ISSN: 0021-9355</identifier><identifier>EISSN: 1535-1386</identifier><identifier>DOI: 10.2106/JBJS.J.01623</identifier><identifier>PMID: 22258780</identifier><language>eng</language><publisher>United States: Copyright by The Journal of Bone and Joint Surgery, Incorporated</publisher><subject>Adolescent ; Age Distribution ; Child ; Cross-Sectional Studies ; Disease Progression ; Female ; Femur Head Necrosis - diagnostic imaging ; Femur Head Necrosis - epidemiology ; Femur Head Necrosis - etiology ; Follow-Up Studies ; Hip Dislocation, Congenital - diagnostic imaging ; Hip Dislocation, Congenital - surgery ; Humans ; Incidence ; Male ; Osteotomy - adverse effects ; Osteotomy - methods ; Pain Measurement ; Radiography ; Range of Motion, Articular - physiology ; Risk Assessment ; Severity of Illness Index</subject><ispartof>Journal of bone and joint surgery. American volume, 2011-12, Vol.93 (24), p.e145-e145</ispartof><rights>Copyright 2011 by The Journal of Bone and Joint Surgery, Incorporated</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2503-3aaf9a3ec485b1dc58c5cb4adb5291b03b54f2b36a8574aa387706232faa1c1c3</citedby><cites>FETCH-LOGICAL-c2503-3aaf9a3ec485b1dc58c5cb4adb5291b03b54f2b36a8574aa387706232faa1c1c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22258780$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Roposch, Andreas</creatorcontrib><creatorcontrib>Liu, Liang Q</creatorcontrib><creatorcontrib>Offiah, Amaka C</creatorcontrib><creatorcontrib>Wedge, John H</creatorcontrib><title>Functional Outcomes in Children with Osteonecrosis Secondary to Treatment of Developmental Dysplasia of the Hip</title><title>Journal of bone and joint surgery. American volume</title><addtitle>J Bone Joint Surg Am</addtitle><description>BACKGROUND:Osteonecrosis of the femoral head is a major potential complication following the treatment of developmental dysplasia of the hip. It remains unclear if the radiographic changes associated with osteonecrosis are clinically relevant.
METHODS:In the present cross-sectional study, we determined the relationship between morphological changes on radiographs (classified with use of the Bucholz-Ogden system) and health-related quality of life (assessed with the Health Utilities Index Mark 3 [HUI3]; maximum score, 1), physical function (assessed with the Activities Scale for Kids [ASK]; maximum score, 100), and hip function (assessed with the Childrenʼs Hospital Oakland Hip Evaluation Scale [CHOHES]; maximum score, 100). The study group included seventy-two children (mean age, 14 ± 2.5 years) with a diagnosis of osteonecrosis of the hip secondary to the treatment of developmental dysplasia of the hip. Patient assessments were standardized (intraclass correlation coefficient, ≥0.93). Radiographs were graded by three experts according to consensus. Analyses were adjusted for the number of previous surgical procedures on the hip and for the severity of residual hip dysplasia.
RESULTS:The median ASK score was 97 (interquartile range, 93 to 100), the median CHOHES score was 86 (interquartile range, 77 to 96), and the median HUI3 score was 1 (interquartile range, 0.9 to 1). The ASK summary scores were nearly equal (median, >90) across all radiographic grades. Adjusted mean scores showed a downward shift with worse radiographic grades. The ASK scores (p = 0.004) and CHOHES scores (p = 0.006) differed across radiographic grades, with Bucholz-Ogden grade-I and II hips demonstrating significantly better scores than grade-III and IV hips.
DISCUSSION:Osteonecrosis secondary to the treatment of developmental dysplasia of the hip is a relatively benign condition in children and teenagers. While it was associated with limited hip function, it was not associated with physical disability. However, we speculate that this function will decline with increasing age. With regard to clinical outcome, Bucholz-Ogden grade-I hips are similar to grade-II hips and grade-III hips are similar to grade-IV hips.
LEVEL OF EVIDENCE:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.</description><subject>Adolescent</subject><subject>Age Distribution</subject><subject>Child</subject><subject>Cross-Sectional Studies</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Femur Head Necrosis - diagnostic imaging</subject><subject>Femur Head Necrosis - epidemiology</subject><subject>Femur Head Necrosis - etiology</subject><subject>Follow-Up Studies</subject><subject>Hip Dislocation, Congenital - diagnostic imaging</subject><subject>Hip Dislocation, Congenital - surgery</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Osteotomy - adverse effects</subject><subject>Osteotomy - methods</subject><subject>Pain Measurement</subject><subject>Radiography</subject><subject>Range of Motion, Articular - physiology</subject><subject>Risk Assessment</subject><subject>Severity of Illness Index</subject><issn>0021-9355</issn><issn>1535-1386</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kcFu1DAQQC0EotvCjTPyjQtZPHacZI-wpS2rSntoOVuOM1EMThxsh1X_HoctnCx7np40z4S8A7blwKpPhy-Hh-1hy6Di4gXZgBSyANFUL8mGMQ7FTkh5QS5j_MEYK0tWvyYXnHPZ1A3bEH-zTCZZP2lHj0syfsRI7UT3g3VdwImebBroMSb0E5rgo430AY2fOh2eaPL0MaBOI06J-p5e4290fl6v2Xf9FGeno9XrKA1I7-z8hrzqtYv49vm8It9vvj7u74r74-23_ef7wnDJRCG07ndaoCkb2UJnZGOkaUvdtZLvoGWilWXPW1HpRtal1qKpa5YD8F5rMGDEFflw9s7B_1owJjXaaNA5PaFfotpBDRXIkmfy45lct4sBezUHO-btFDC1FlZrYXVQfwtn_P2zeGlH7P7D_5JmoDwDJ-8ShvjTLScMakDt0qDY-gnZU3AGADz7i_wCQvwBn5mHfw</recordid><startdate>20111221</startdate><enddate>20111221</enddate><creator>Roposch, Andreas</creator><creator>Liu, Liang Q</creator><creator>Offiah, Amaka C</creator><creator>Wedge, John H</creator><general>Copyright by The Journal of Bone and Joint Surgery, Incorporated</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20111221</creationdate><title>Functional Outcomes in Children with Osteonecrosis Secondary to Treatment of Developmental Dysplasia of the Hip</title><author>Roposch, Andreas ; Liu, Liang Q ; Offiah, Amaka C ; Wedge, John H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2503-3aaf9a3ec485b1dc58c5cb4adb5291b03b54f2b36a8574aa387706232faa1c1c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adolescent</topic><topic>Age Distribution</topic><topic>Child</topic><topic>Cross-Sectional Studies</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Femur Head Necrosis - diagnostic imaging</topic><topic>Femur Head Necrosis - epidemiology</topic><topic>Femur Head Necrosis - etiology</topic><topic>Follow-Up Studies</topic><topic>Hip Dislocation, Congenital - diagnostic imaging</topic><topic>Hip Dislocation, Congenital - surgery</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Osteotomy - adverse effects</topic><topic>Osteotomy - methods</topic><topic>Pain Measurement</topic><topic>Radiography</topic><topic>Range of Motion, Articular - physiology</topic><topic>Risk Assessment</topic><topic>Severity of Illness Index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Roposch, Andreas</creatorcontrib><creatorcontrib>Liu, Liang Q</creatorcontrib><creatorcontrib>Offiah, Amaka C</creatorcontrib><creatorcontrib>Wedge, John H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of bone and joint surgery. American volume</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Roposch, Andreas</au><au>Liu, Liang Q</au><au>Offiah, Amaka C</au><au>Wedge, John H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Functional Outcomes in Children with Osteonecrosis Secondary to Treatment of Developmental Dysplasia of the Hip</atitle><jtitle>Journal of bone and joint surgery. American volume</jtitle><addtitle>J Bone Joint Surg Am</addtitle><date>2011-12-21</date><risdate>2011</risdate><volume>93</volume><issue>24</issue><spage>e145</spage><epage>e145</epage><pages>e145-e145</pages><issn>0021-9355</issn><eissn>1535-1386</eissn><abstract>BACKGROUND:Osteonecrosis of the femoral head is a major potential complication following the treatment of developmental dysplasia of the hip. It remains unclear if the radiographic changes associated with osteonecrosis are clinically relevant.
METHODS:In the present cross-sectional study, we determined the relationship between morphological changes on radiographs (classified with use of the Bucholz-Ogden system) and health-related quality of life (assessed with the Health Utilities Index Mark 3 [HUI3]; maximum score, 1), physical function (assessed with the Activities Scale for Kids [ASK]; maximum score, 100), and hip function (assessed with the Childrenʼs Hospital Oakland Hip Evaluation Scale [CHOHES]; maximum score, 100). The study group included seventy-two children (mean age, 14 ± 2.5 years) with a diagnosis of osteonecrosis of the hip secondary to the treatment of developmental dysplasia of the hip. Patient assessments were standardized (intraclass correlation coefficient, ≥0.93). Radiographs were graded by three experts according to consensus. Analyses were adjusted for the number of previous surgical procedures on the hip and for the severity of residual hip dysplasia.
RESULTS:The median ASK score was 97 (interquartile range, 93 to 100), the median CHOHES score was 86 (interquartile range, 77 to 96), and the median HUI3 score was 1 (interquartile range, 0.9 to 1). The ASK summary scores were nearly equal (median, >90) across all radiographic grades. Adjusted mean scores showed a downward shift with worse radiographic grades. The ASK scores (p = 0.004) and CHOHES scores (p = 0.006) differed across radiographic grades, with Bucholz-Ogden grade-I and II hips demonstrating significantly better scores than grade-III and IV hips.
DISCUSSION:Osteonecrosis secondary to the treatment of developmental dysplasia of the hip is a relatively benign condition in children and teenagers. While it was associated with limited hip function, it was not associated with physical disability. However, we speculate that this function will decline with increasing age. With regard to clinical outcome, Bucholz-Ogden grade-I hips are similar to grade-II hips and grade-III hips are similar to grade-IV hips.
LEVEL OF EVIDENCE:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.</abstract><cop>United States</cop><pub>Copyright by The Journal of Bone and Joint Surgery, Incorporated</pub><pmid>22258780</pmid><doi>10.2106/JBJS.J.01623</doi></addata></record> |
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subjects | Adolescent Age Distribution Child Cross-Sectional Studies Disease Progression Female Femur Head Necrosis - diagnostic imaging Femur Head Necrosis - epidemiology Femur Head Necrosis - etiology Follow-Up Studies Hip Dislocation, Congenital - diagnostic imaging Hip Dislocation, Congenital - surgery Humans Incidence Male Osteotomy - adverse effects Osteotomy - methods Pain Measurement Radiography Range of Motion, Articular - physiology Risk Assessment Severity of Illness Index |
title | Functional Outcomes in Children with Osteonecrosis Secondary to Treatment of Developmental Dysplasia of the Hip |
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