1. MRI risk factors for development of avascular necrosis after closed reduction of developmental dysplasia of the hip: Predictive value of contrast-enhanced MRI
- Author
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Won Joon Yoo, Young Hun Choi, Jung Eun Cheon, Tae Joon Cho, Jiyoung Kim, and Woo Sun Kim
- Subjects
Male ,CONTRAST ENHANCED MRI ,Physiology ,Epidemiology ,medicine.medical_treatment ,Radiography ,Contrast Media ,Avascular necrosis ,Ossification ,Diagnostic Radiology ,030218 nuclear medicine & medical imaging ,Postoperative Complications ,Mathematical and Statistical Techniques ,0302 clinical medicine ,Skeletal Joints ,Femur Head Necrosis ,Risk Factors ,Medicine and Health Sciences ,Orthopedic Procedures ,Postoperative Period ,Musculoskeletal System ,030222 orthopedics ,Multidisciplinary ,medicine.diagnostic_test ,Radiology and Imaging ,Statistics ,Femur Head ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Connective Tissue ,Physical Sciences ,Developmental Dysplasia of the Hip ,Regression Analysis ,Medicine ,Female ,Hip Joint ,Bone Remodeling ,Anatomy ,medicine.symptom ,Epiphyses ,Research Article ,Imaging Techniques ,Science ,Research and Analysis Methods ,Risk Assessment ,Pelvis ,03 medical and health sciences ,Femoral head ,Diagnostic Medicine ,medicine ,Humans ,Statistical Methods ,Bone ,Skeleton ,Reduction (orthopedic surgery) ,Retrospective Studies ,Hip ,business.industry ,Developmental dysplasia ,Infant ,Biology and Life Sciences ,Magnetic resonance imaging ,medicine.disease ,Biological Tissue ,Cartilage ,Medical Risk Factors ,Physiological Processes ,business ,Nuclear medicine ,Mathematics - Abstract
Purpose The purpose of this study was to identify imaging risk factors on contrast-enhanced hip MRI after closed reduction of developmental dysplasia of the hip (DDH) that could predict future development of avascular necrosis (AVN) of the femoral head. Materials and methods Fifty-eight infants (F: M = 53: 5, aged 3–18 months) who underwent immediate postoperative contrast-enhanced hip MRI after closed reduction of DDH were included in this study. Quality of reduction (concentric vs eccentric reduction with or without obstacles), abduction angle of the hip, presence of ossific nucleus, and pattern of contrast enhancement of the femoral head were retrospectively evaluated on MRI. Interobserver agreement of contrast enhancement pattern on MRI were evaluated by two radiologists. Development of AVN was determined through radiographic findings at 1 year after reduction. Results AVN of the femoral head developed in 13 (22%) of 58 patients. Excessive abduction of the hip joint (OR 4.65, [95% CI 1.20, 18.06] and global decreased enhancement of the femoral head (OR 71.66, [95% CI 10.54, 487.31]) exhibited statistically significant differences between the AVN and non-AVN groups (P < 0.05). Eccentric reduction (P = 0.320) did not show statistically significant difference between two groups and invisible ossific nucleus (P = 0.05) showed borderline significance. Multi-variable logistic regression indicated that global decreased enhancement of the femoral head was a significant risk factor of AVN (OR 27.92, 95% CI [4.17, 350.18]) (P = 0.0031). Interobserver agreement of contrast enhancement pattern analysis and diagnosis of AVN were good (0.66, 95% CI [0.52, 0.80]). Conclusion Contrast-enhanced hip MRI provides accurate anatomical assessment of the hip after closed reduction of DDH. Global decreased enhancement of the femoral head could be used as a good predictor for future development of AVN after closed reduction of DDH.
- Published
- 2021