Medical Malpractice Insurance for orthopaedic surgeons
Home » Joints » Hip » Avascular Necrosis Associated w/ DDH

Avascular Necrosis Associated w/ DDH

- See: AVN in Adults

- Discussion:
    - results from forced attempts at reduction and subsequent disruption of the blood supply to the growing femoral head;
           - is reported to occur in 6-30% of patients undergoing closed reduction, but in some series the incidence can be as high as 45%;
           - AVN is extremely rare in untreated patients w/ DDH (see natural history);
    - children older than age 2-3 are most at risk for AVN;
    - w/ secondary soft tissue adaptive changes, forced reduction, places tension on soft tissue structures surrounding the hip comprimising its blood supply;
           - forced abduction is a likely risk factor;
           - medial circumflex femoral artery may be stretched & compressed w/ thigh in full abduction;
           - MCFA may also be compressed between labrum & femoral neck;
           - methods to reduce the incidence of AVN include releasing tendons and tight soft tissues about the hip, shortening the femur, and avoiding immobilization;

- Type II Growth Disturbance:
    - lateral tilting of the capital femoral epiphysis is the hallmark for the type II disturbance;
    - usually evident by an average age of ten years of age;
    - late appearance of valgus tilt of the femoral head

Avascular necrosis following treatment of congenital dislocation of the hip.

The effects of contact pressure elevations and aseptic necrosis on long term outcome of congenital hip dislocation

Acetabular Development in Developmental Dysplasia of the Hip Complicated by Lateral Growth Disturbance of the Capital Femoral Epiphysis

Management of ischemic deformity after the treatment of developmental dysplasia of the hip.