Abstract
Aims
Traumatic hip dislocations are considered orthopaedic emergencies that are treated with urgent reduction to decrease the rate of osteonecrosis of the femoral head. The aim of our study was to systematically review the literature that compares late (>6 h from the time of injury) to early (<6 h from the time of injury) reduction in all traumatic hip dislocations.
Materials and methods
We searched five databases from 1951 to 2016 for studies that evaluated timing of reduction and osteonecrosis of the femoral head in all traumatic hip dislocations. We performed a meta-analysis using a random-effects model to pool odds ratios (ORs) for a comparison of osteonecrosis of the femoral head between patients undergoing late versus early hip reduction. We also investigated the osteonecrosis rate in low- and high-grade traumatic hip dislocations. Descriptive, quantitative and qualitative data were extracted.
Results
Of the 13 articles identified, five studies (retrospective cohort studies) were eligible for the meta-analysis, encompassing a total of 236 traumatic hip dislocations. The pooled odds ratio for osteonecrosis of the femoral head between late and early reduction was in favour of early hip reduction and statistically significant (OR = 5.00, 95% CI: 1.30, 19.29). No significant difference in the rate of osteonecrosis of the femoral head was detected between low- and high-grade traumatic hip dislocations according to the time threshold (OR = 1.71, 95% CI: 0.22, 13.22).
Conclusions
The cumulative evidence at present does indicate an association between late hip reduction and higher rate of osteonecrosis of the femoral head in all traumatic hip dislocations. Hence, all traumatic hip dislocations should be reduced as soon as possible to decrease the rate of osteonecrosis of the femoral head. However, the evidence does not indicate an association between the grade of dislocation and rate of osteonecrosis of the femoral head.
Level of evidence
III.
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References
Sahin V, Karakas ES, Asus A, Athan D, Turk CY, Halici M (2003) Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study. J Trauma 55:946–948
Rockwood and Green’s Fractures in Adults, 7th Edition. (2010) Lippincott Williams & Wilkins, Baltimore, United States of America
Dwyer AJ, John B, Singh SA, Mam MK (2006) Complications after posterior dislocation of the hip. Int Orthop 30:224–227
Thompson VP, Epstein HC (1951) Traumatic dislocation of the hip: a survey of 204 cases covering a period of twenty-one years. J Bone Joint Surg Am 33:74–78
Pipkin G (1975) Treatment of grade IV fracture-dislocation of the hip. J Bone Joint Surg Am 39:1027–1042
Sanders S, Tejwani N, Egol KA (2010) Traumatic hip dislocation: a review. Bull NYU Hosp Jt Dis 68:91–96
Epstein HC (1973) Traumatic dislocations of the hip. Clin Orthop Relat Res 92:116–142
Yang RS, Tsuang YH, Hang YS, Liu TK (1991) Traumatic dislocation of the hip. Clin Orthop Relat Res 265:218–227
Upadhyay SS, Moulton A, Burwell RG (1985) Biological factors predisposing to traumatic posterior dislocation of the hip. A selection process in the mechanism of injury. J Bone Joint Surg Br 67:232–236
Kaushik AP, Das A, Cui Q (2012) Osteonecrosis of the femoral head: an update in year 2012. World J Orthop 3:49–57
Hougaard K, Thomsen PB (1986) Traumatic posterior dislocation of the hip—prognostic factors influencing the incidence of avascular necrosis of the femoral head. Arch Orthop Trauma Surg 106:32–35
Upadhyay SS, Moulton A (1981) The long-term results of traumatic posterior dislocation of the hip. J Bone Joint Surg Br 63:548–551
Rodríguez-Merchán EC, Goddard NJ (2000) Traumatic dislocation of the hip. Clin Orthop Relat Res 377:2–3
Hougaard K, Thomsen PB (1987) Coxarthrosis following traumatic posterior dislocation of the hip. J Bone Joint Surg Am 69:679–683
Sen RK, Tripathy SK, Gill SS, Verma N, Singh P, Radotra BD (2010) Prediction of posttraumatic femoral head osteonecrosis by quantitative intraosseous aspirate and core biopsy analysis: a prospective study. Acta Orthop Belgica 76:486–492
Moore D (2016) Recommended time to reduce hip dislocations. http://www.orthobullets.com/eFootprint/view.aspx. Accessed 3 Dec 2016
Watson JT (2011) Timing of reduction: does it matter? http://aaos.org/news/aaosnow/may11/clinical2.asp. Accessed 3 Dec 2016
Sapkas G, Pantazopoulos T, Karanikas E, Hartofilakidis-Garofalidis G (1983) Effect of hip dislocation on the blood supply to the femoral head. An experimental study in rabbits. Acta Orthop Scand 54:204–209
Kellam P, Ostrum RF (2016) Systematic review and meta-analysis of avascular necrosis and posttraumatic arthritis after traumatic hip dislocation. J Orthop Trauma 30:10–16
Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. J Clin Epidemiol 62:1006–1012
Wells GA, Shea B, O’Connell D, Petersen J, Welch V, Losos M, Tugwell P (2014) The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Department of Epidemiology and Community Medicine, University of Ottawa, Canada. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188
Higgins JPT, Green S (eds). (updated March 2011) Cochrane handbook for systematic reviews of interventions, version 5.1.0. The Cochrane Collaboration, Oxford, United Kingdom. http://www.cochrane-handbook.org
Dreinhofer KE, Schwarzkopf SR, Haas NP, Tscherne H (1994) Isolated traumatic dislocation of the hip. Long-term results in 50 patients. J Bone Joint Surg Br 76:6–12
Marchetti ME, Steinberg GG, Coumas JM (1996) Intermediate-term experience of Pipkin fracture-dislocations of the hip. J Orthop Trauma 10:455–461
Mitsionis GI, Lykissas MG, Motsis E, Mitsiou D, Gkiatas I, Xenakis TA, Beris AE (2012) Surgical management of posterior hip dislocations associated with posterior wall acetabular fracture: a study with a minimum follow-up of 15 years. J Orthop Trauma 26:460–465
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Ahmed, G., Shiraz, S., Riaz, M. et al. Late versus early reduction in traumatic hip dislocations: a meta-analysis. Eur J Orthop Surg Traumatol 27, 1109–1116 (2017). https://doi.org/10.1007/s00590-017-1988-7
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DOI: https://doi.org/10.1007/s00590-017-1988-7