Proximal Femoral Growth Alterations Can Be Seen Prior to Treatment of Developmental Dysplasia of the Hip: A Multicenter Cohort Study
Bibliographic record
Abstract
Background: Avascular necrosis (AVN), better considered proximal femoral growth disturbance (PFGD), following treatment for developmental dysplasia of the hip (DDH) remains poorly defined. In addition to limited reliability, it has been our experience that some radiographic features attributed to AVN/PFGD may be present prior to surgery. Our purpose was to determine the baseline prevalence of radiographic features suggestive of PFGD in a diverse population with surgically-treated DDH. Methods: The prospectively collected database for an international multicenter study group was retrospectively queried for patients undergoing surgery for DDH with minimum one-year radiographic and clinical follow-up. Preoperative radiographs were evaluated for findings typically used to define PFGD at follow-up. Development of actual AVN/PFGD was determined by consensus review of follow-up radiographs by three experts separate from this study. Results: 145 patients were evaluated, with median preoperative age of 16.8 months (IQR:10.7-25.60). The proportion of patients with initial IHDI grades of 2, 3, or 4 was 18%, 32%, and 50%, respectively. Prior to surgery, 20 hips (14%) had a heterogenous or “fragmented” epiphysis. Eight of the 145 epiphyses (6%) were significantly ellipsoid in shape. Depending on the definition, between 5-10% of hips had a wider neck at baseline compared to the contralateral, normal hip. At final follow-up, 42% of the hips were determined to have PFGD based on consensus review. Of all the patients that were considered to have PFGD at follow-up, 59% of patients had one feature of PFGD at baseline, and 20% had two or more. Conclusions: The current study suggests that several factors used to define the development of PFGD following DDH surgery may be present prior to surgical intervention. Our data demonstrates that 20% of the patients who develop AVN have at least two markers of PFGD, per Salter criteria, prior to receiving any treatment. This suggests that some of these hips may not be morphologically “normal” at baseline and adds to the mounting body of evidence about the limitations of the Salter classification for AVN.
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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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".