Avascular Necrosis of Femoral Head Following Closed Reduction in Cases of Developmental Dysplasia of the Hip Among Infants

Abstract

Background: Avascular necrosis (AVN) of the femoral head is a serious complication following treatment for developmental dysplasia of the hip (DDH) in infants. Although several risk factors have been proposed, there remains uncertainty regarding the role of patient age, sex, hip side, and treatment technique in AVN development. This study aimed to determine the incidence and associated risk factors for AVN in infants undergoing closed reduction for DDH. Methods: A retrospective descriptive study was conducted on 124 infants (5–12 months old) treated for DDH at two specialized centers in Duhok City, Iraq, between January 2019 and December 2023. Patients underwent closed reduction with or without adductor tenotomy and with or without pre-reduction traction. All were followed clinically and radiographically for at least two years. AVN diagnosis was based on Salter criteria and graded using the Bucholz–Ogden and Kalamchi–MacEwen classifications. Categorical variables were compared using the Chi-square test, with p < 0.05 considered statistically significant. Results: The overall incidence of AVN was 18.5%. AVN rates did not differ significantly between the 5–8 month group (18.3%) and the 9–12 month group (18.8%, p = 0.06), nor by sex or side of involvement. Adductor tenotomy was associated with a significantly lower incidence of AVN (11.2% vs. 46.1% without tenotomy, p = 0.001). Pre-reduction traction also reduced AVN risk (9.1% vs. 41.6% without traction, p = 0.001). Conclusion: In this cohort, age, sex, and side were not significant predictors of AVN after closed reduction for DDH. The use of adductor tenotomy and pre-reduction traction markedly reduced AVN incidence, highlighting the importance of soft-tissue management and gentle, tension-free reduction techniques.