THE INCIDENCE OF AVASCULAR NECROSIS AND RADIOGRAPHIC OUTCOME FOLLOWING MEDIAL OPEN REDUCTION IN DEVELOPMENTAL HIP DYSPLASIA: A SYSTEMATIC REVIEW
Bibliographic record
Abstract
Aim To establish the incidence of clinically significant avascular necrosis (AVN) and the resultant influence on radiological outcome following medial open reduction for DDH. Method A systematic review of the literature was performed using Medline and Embase, from 1946 to 2012, to identify all relevant clinical studies. We excluded papers with a mean follow-up under 5 years. The effect of length of follow-up, outcome according to Severin, age at surgery, and type of growth disturbance were reviewed. Results 2439 citations were identified. 17 papers reporting 734 hips met the inclusion criteria. These were submitted for data extraction. Mean follow-up was 10.9 years (2–28 years). The rate of clinically significant AVN (types 2–4) was 20%. From these papers 221 hips had sufficient information to permit more detailed analysis. The AVN incidence increased with follow-up to 24% at skeletal maturity. Type 2 AVN predominated after 5 years follow-up. The presence of AVN resulted in a higher incidence of unsatisfactory outcome (55% vs 20% in hips without AVN, p 12 months, p 0.022). However, more subsequent surgery was performed in the older group (18.3% vs 35.6%, p 0.004). Conclusion Medial open reduction is associated with a 24% incidence of AVN at skeletal maturity. The rate of AVN increases with longer follow-up with type 2 predominating. AVN results in a significantly higher rate of unsatisfactory outcomes. When surgery is performed under 12 months of age the rate of AVN is higher, however the overall need for subsequent surgery is less.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.037 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.005 |
| Bibliometrics | 0.012 | 0.013 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".