Impact of avascular necrosis on outcomes in the management of developmental dysplasia of hip: a systematic review

Avascular necrosis (AVN) is a known complication during the management of developmental dysplasia of the hip (DDH). It has the potential to alter the growth of the head or acetabulum and prevent the best outcomes. While past literature has evaluated the risks of AVN and strategies to avoid it, studies on the impact of AVN on the outcomes are scarce. In this systematic review, we aim to study the extent of the effects of AVN on the outcomes, in the management of DDH. In this systematic review series for 1990 to 2021 were pooled. The clinical and radiological outcomes of the AVN and non-AVN groups were compared. The effects of other modifying factors were also evaluated. A total of 170 AVN and 585 non-AVN hips from 21 papers were compared. The analysis did not show any statistically significant difference between the AVN and non-AVN groups in terms of clinical or radiological parameters. Interestingly patients who had the index surgery at a younger age had a higher risk of further surgery, with acetabular osteotomy being the most common secondary procedure. The negative impact of AVN may not be as severe as previously thought. Thus, the fear of AVN should not take precedence over the primary goal of DDH management i.e. obtaining a stable concentric mobile hip.