Presence of the Ossific Nucleus and Risk of Osteonecrosis in the Treatment of Developmental Dysplasia of the Hip
Bibliographic record
Abstract
BACKGROUND: Concern for increased risk of osteonecrosis in hips with an absent ossific nucleus has led some surgeons to delay reduction in the treatment of developmental dysplasia of the hip (DDH) until the ossific nucleus is present. A previous meta-analysis reported a potential protective effect against high-grade osteonecrosis (II to IV) when the ossific nucleus was present. With a greater number of publications on this topic, revisiting this analysis is warranted. The aim of this meta-analysis was to systematically review and analyze the best clinical evidence regarding the association between the status of the ossific nucleus and development of osteonecrosis following the treatment of DDH. METHODS: MEDLINE, Embase, and Cochrane databases were systematically searched for studies including the status of the ossific nucleus and rate of osteonecrosis after open and closed reductions for the treatment of DDH. Study characteristics and risk estimates were extracted. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled effect estimates were calculated using a random-effect model. Meta-regression assessed the relationships of reduction method, study quality, mean age at reduction, surgical approach, method of ossific nucleus assessment, and duration of follow-up to the odds of osteonecrosis. RESULTS: In the 21 observational studies (18 retrospective, 3 prospective) that were included, osteonecrosis developed in 20.4% of the hips in which the ossific nucleus was present at reduction compared with 21.2% of the hips in which the ossific nucleus was absent. Presence of the ossific nucleus was not associated with decreased odds of any grade of osteonecrosis (odds ratio [OR] = 0.70, 95% confidence interval [CI] = 0.43 to 1.12) or of more severe osteonecrosis of Grades II to IV (OR = 0.70, 95% CI = 0.30 to 1.17). Meta-regression did not show any effect of the mean age at reduction, reduction method, surgical approach, study quality, minimum or mean duration of follow-up, method of ossific nucleus imaging, or osteonecrosis classification system on the relationship between presence of the ossific nucleus and the risk of osteonecrosis. CONCLUSIONS: The current literature does not support the hypothesis that presence of the ossific nucleus at reduction is associated with lower risk of osteonecrosis. Prospective studies with long-term follow-up and blinded assessors are warranted to optimally evaluate the relationship between potential risk factors and the development of osteonecrosis. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".