Meta-analysis identifies three independent risk factors for AVN after DDH surgery in children

This systematic review and meta-analysis examined risk factors for avascular necrosis following surgical treatment of developmental dysplasia of the hip in pediatric patients. The analysis included data from 1,631 patients (1,941 hips), though specific study designs, follow-up duration, and setting were not reported. The primary outcome was AVN, with no comparator group specified.

The multivariate meta-analysis identified three independent risk factors for AVN. Absence of the ossific nucleus was associated with a 2.60-fold increased odds of AVN (95% CI 1.73-3.91, P=0.001). Higher grade dislocations (IHDI classification grade III/IV) were associated with a 2.43-fold increased odds (95% CI 1.46-4.03, P=0.001). Secondary procedures were associated with a 2.56-fold increased odds (95% CI 1.02-6.46, P=0.046). Absolute event numbers were not reported.

Safety assessment focused on AVN as the primary adverse event, with serious adverse events, discontinuations, and tolerability not reported. Key limitations include the absence of reported certainty assessments, funding disclosures, and specific study-level limitations. The observational nature of the included studies means these are associations, not proven causal relationships.

For clinical practice, this analysis suggests that surgeons should be particularly vigilant for AVN risk in children with higher grade dislocations, absent ossific nucleus, or those requiring secondary procedures. These factors may influence surgical timing decisions and preoperative counseling, though individual patient factors and surgeon experience remain paramount.