Castañeda LP, Iturbide SP

Language: Spanish
References: 14
Page: 47-52
PDF size: 318.72 Kb.

ABSTRACT

The most feared complication in the treatment of developmental dysplasia of the hip is avascular necrosis, which is a completely iatrogenic condition as it does not occur in untreated hips; it has a variable incidence in the literature ranging from cero to up to 73%. The exact cause is still the subject of controversy, with a vascular insult being the most predominant theory, however a mechanical origin caused by pressure on the chondroepiphysis is also frequently mentioned; the final result of any pathologic process is a state of hypoperfusion of the femoral head. This article will present a review of the current knowledge on the pathophysiology and a review of the current methods that are used to evaluate femoral head perfusion including ultrasound, Doppler and contrast magnetic resonance imaging; with a special focus on their interpretation for the decision making process in the treatment of this condition.

REFERENCES

1. Klisic PJ. Congenital dislocation of the hip: a misleading term-brief report. J Bone Joint Surg Br. 1989; 71: 136.

2. Atsumi T, Kuroki Y. Role of impairment of blood supply of the femoral head in the pathogenesis of idiopathic osteonecrosis. Clin Orthop Relat Res. 1992; 277: 22- 30.

3. Brougham DI, Broughton NS, Cole WG, Menelaus MB. The predictability of acetabular development after closed reduction for congenital dislocation of the hip. J Bone Joint Surg Br. 1988; 70: 733-736.

4. Cooperman DR, Wallensten R, Stulberg SD. Acetabular dysplasia in the adult. Clin Orthop Relat Res. 1983; 173: 79-85.

5. Kerachian MA, Harvey EJ, Cournoyer D, Chow TY, Séguin C. Avascular necrosis of the femoral head: vascular hypotheses. Endothelium. 2006; 13(4): 237-44.

6. Eijer H. Towards a better understanding of the aetiology of Legg-Calvé-Perthes’ disease: acetabular retroversion may cause abnormal loading of dorsal femoral head-neck junction with restricted blood supply to the femoral epiphysis. Med Hypotheses. 2007; 68(5): 995-997.

7. Roposch A, Stöhr KK, Dobson M. The effect of the femoral head ossific nucleus in the treatment of developmental dysplasia of the hip. A meta-analysis. J Bone Joint Surg Am. 2009; 91(4): 911-918.

8. Bucholz R, Ogden JA. Patterns of ischemic necrosis of the proximal femur in nonoperatively treated congenital hip disease. St. Louis: CV Mosby Co; 1978: 43-63.

9. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1980; 62: 876-888.

10. Kim HW, Morcuende JA, Dolan LA, Weinstein SL. Acetabular development in developmental dysplasia of the hip complicated by lateral growth disturbance of the capital femoral epiphysis. J Bone Joint Surg Am. 2000; 82: 1692-1700.

11. Brougham DI, Broughton NS, Cole WG, Menelaus MB. Avascular necrosis following closed reduction of congenital dislocation of the hip. Review of influencing factors and long-term follow-up. J Bone Joint Surg Br. 1990; 72: 557-562

12. Barnewolt CE, Jaramillo D, Taylor GA, Dunning PS. Correlation of contrast-enhanced power Doppler sonography and conventional angiography of abduction-induced hip ischemia in piglets. AJR Am J Roentgenol. 2003; 180(6): 1731-1735.

13. Doria AS, Guarniero R, Cunha FG, Modena M, De Godoy RM Jr, Luzo C, Neto RB, Molnar LJ, Cerri GG. Contrast-enhanced power Doppler sonography: assessment of revascularization flow in Legg-Calvé-Perthes’ disease. Med Biol. 2002; 28(2): 171-182.

14. Jaramillo D, Villegas-Medina OL, Doty DK, Dwek JR, Ransil BJ, Mulkern RV, Shapiro F. Gadolinium-enhanced MR imaging demonstrates abduction-caused hip ischemia and its reversal in piglets. Pediatr Radiol. 1995; 25(8): 578-587.