{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:45:19Z","timestamp":1790858719293,"version":"4.1.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7,15]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Surgical hip reduction is an accepted treatment option for infantile developmental dysplasia of the hip (DDH) but may be complicated by the development of osteonecrosis, recently re-termed\n                      <jats:italic toggle=\"yes\">proximal femoral growth disturbance (PFGD)<\/jats:italic>\n                      . Since the etiology of PFGD is likely related to compromised vascular supply to the femoral head, the need exists for an intraoperative method of assessing changes in femoral head perfusion prior to irreversible injury. This study sought to utilize contrast-enhanced ultrasound (CEUS) to assess intraoperative changes in perfusion following surgical reduction for infantile DDH, with the ultimate goal of predicting and eventually preventing PFGD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this prospective study, CEUS was performed before and immediately after surgical reduction and spica casting in infants undergoing surgery for DDH between 4 and 18 months of age. Delta projections were used to quantitatively analyze changes in perfusion, and a statistical analysis was performed to assess the relationships between patient factors, including casting position, and changes in epiphyseal perfusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The study population of 32 patients included 34 hips, comprising 30 hips of female patients (88.2%) and 4 hips of male patients (11.8%), with a mean age and standard deviation of 9.3 \u00b1 3.3 months. A lower perfusion index following surgical reduction (p = 0.003) was seen in the majority (79.4%) of hips. In the remaining hips, a higher perfusion index was observed following reduction (p = 0.03). The greatest significant decreases in perfusion index were observed in the central region of the femoral head epiphysis (p = 0.002), followed by the peripheral region of the femoral head epiphysis (p = 0.03). Axial abduction was correlated with a post-reduction decrease in perfusion index (r = 0.35; p = 0.04). There was a moderately positive correlation between body mass index (BMI) and a post-reduction change in perfusion index (r = 0.45; p = 0.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>There was wide variation in post-reduction changes in femoral head perfusion after surgical hip reduction and spica casting for infantile DDH, with a gradient of change across the regions of the femoral head. In addition, BMI and in-cast hip position seemed to influence perfusion changes. With continued analysis of these relationships and longer follow-up from our ongoing prospective investigation, we aim to identify the risk factors for PFGD development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.25.00863","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T19:00:14Z","timestamp":1770058814000},"page":"1083-1091","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Femoral Head Perfusion Varies Widely Following Surgical Reduction for Infantile Developmental Dysplasia of the Hip"],"prefix":"10.2106","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8650-6907","authenticated-orcid":false,"given":"Martha","family":"Kebeh","sequence":"first","affiliation":[{"name":"Orthopedic Center, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2632-4164","authenticated-orcid":false,"given":"Laith R.","family":"Sultan","sequence":"additional","affiliation":[{"name":"Division of Body Imaging, Department of Radiology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6196-3871","authenticated-orcid":false,"given":"Carter E.","family":"Hall","sequence":"additional","affiliation":[{"name":"Orthopedic Center, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7145-0277","authenticated-orcid":false,"given":"Carlos","family":"Yaya","sequence":"additional","affiliation":[{"name":"Division of Body Imaging, Department of Radiology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3542-3026","authenticated-orcid":false,"given":"Trudy","family":"Morgan","sequence":"additional","affiliation":[{"name":"Division of Body Imaging, Department of Radiology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9672-5775","authenticated-orcid":false,"given":"Susan J.","family":"Back","sequence":"additional","affiliation":[{"name":"Division of Body Imaging, Department of Radiology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8763-9671","authenticated-orcid":false,"given":"Wudbhav N.","family":"Sankar","sequence":"additional","affiliation":[{"name":"Orthopedic Center, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"issue":"11","key":"bib1-20260909","doi-asserted-by":"crossref","first-page":"886","DOI":"10.5312\/wjo.v6.i11.886","article-title":"Developmental dysplasia of the hip: What has changed in the last 20 years?","volume":"6","author":"Kotlarsky","year":"2015","journal-title":"World J Orthop."},{"issue":"1","key":"bib2-20260909","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1542\/peds.103.1.93","article-title":"Developmental dysplasia of the hip: a new approach to incidence","volume":"103","author":"Bialik","year":"1999","journal-title":"Pediatrics."},{"issue":"4","key":"bib3-20260909","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1302\/0301-620X.52B4.704","article-title":"Acetabular dysplasia and familial joint laxity: two etiological factors in congenital dislocation of the hip. A review of 589 patients and their families","volume":"52","author":"Wynne-Davies","year":"1970","journal-title":"J Bone Joint Surg Br."},{"issue":"4","key":"bib4-20260909","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/BF00571474","article-title":"The natural course of osteoarthritis of the hip due to subluxation or acetabular dysplasia","volume":"111","author":"Hasegawa","year":"1992","journal-title":"Arch Orthop Trauma Surg."},{"issue":"3","key":"bib5-20260909","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1615\/JLongTermEffMedImplants.2022040393","article-title":"Developmental Dysplasia of the Hip: A Review","volume":"32","author":"Sioutis","year":"2022","journal-title":"J Long Term Eff Med Implants."},{"issue":"6","key":"bib6-20260909","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1007\/s11832-011-0370-2","article-title":"Residual hip dysplasia as a risk factor for osteoarthritis in 45 years follow-up of late-detected hip dislocation","volume":"5","author":"Terjesen","year":"2011","journal-title":"J Child Orthop."},{"issue":"1","key":"bib7-20260909","doi-asserted-by":"crossref","first-page":"112","DOI":"10.2106\/00004623-197961010-00020","article-title":"Acetabular development after reduction in congenital dislocation of the hip","volume":"61","author":"Lindstrom","year":"1979","journal-title":"J Bone Joint Surg Am."},{"key":"bib8-20260909","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1097\/00003086-197811000-00026","article-title":"Long-term results of closed reduction of complete congenital dislocation of the hip in children under one year of age","volume":"137","author":"Ishii","year":"1978","journal-title":"Clin Orthop Relat Res."},{"issue":"12","key":"bib9-20260909","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.2106\/00004623-199412000-00004","article-title":"Closed reduction for congenital dysplasia of the hip. Functional and radiographic results after an average of thirty years","volume":"76","author":"Malvitz","year":"1994","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib10-20260909","doi-asserted-by":"crossref","first-page":"876","DOI":"10.2106\/00004623-198062060-00002","article-title":"Avascular necrosis following treatment of congenital dislocation of the hip","volume":"62","author":"Kalamchi","year":"1980","journal-title":"J Bone Joint Surg Am."},{"issue":"12","key":"bib11-20260909","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.2106\/00004623-199812000-00001","article-title":"The prognostic importance of the ossific nucleus in the treatment of congenital dysplasia of the hip","volume":"80","author":"Luhmann","year":"1998","journal-title":"J Bone Joint Surg Am."},{"key":"bib12-20260909","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.2147\/TCRM.S166531","article-title":"Prereduction traction for the prevention of avascular necrosis before closed reduction for developmental dysplasia of the hip: a meta-analysis","volume":"14","author":"Park","year":"2018","journal-title":"Ther Clin Risk Manag."},{"issue":"1","key":"bib13-20260909","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1186\/s12891-024-07575-y","article-title":"Risk factors for avascular necrosis of the femoral head after developmental hip dislocation reduction surgery and construction of Nomogram prediction model","volume":"25","author":"Tang","year":"2024","journal-title":"BMC Musculoskelet Disord."},{"issue":"2","key":"bib14-20260909","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1302\/0301-620X.96B2.32361","article-title":"The incidence of avascular necrosis and the radiographic outcome following medial open reduction in children with developmental dysplasia of the hip: a systematic review","volume":"96-B","author":"Gardner","year":"2014","journal-title":"Bone Joint J."},{"issue":"3","key":"bib15-20260909","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1177\/112070000901900302","article-title":"Hip arthroplasty up to the age of 30 and considerations in relation to subsequent revision","volume":"19","author":"Tabutin","year":"2009","journal-title":"Hip Int."},{"issue":"2","key":"bib16-20260909","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s00264-003-0522-1","article-title":"Avascular necrosis after surgical treatment for development dysplasia of the hip","volume":"28","author":"Domzalski","year":"2004","journal-title":"Int Orthop."},{"issue":"2","key":"bib17-20260909","doi-asserted-by":"crossref","first-page":"247","DOI":"10.2106\/00004623-198062020-00012","article-title":"Post-reduction avascular necrosis in congenital dislocation of the hip","volume":"62","author":"Cooperman","year":"1980","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib18-20260909","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1097\/01241398-199903000-00008","article-title":"Avascular necrosis after treatment of DDH: the protective influence of the ossific nucleus","volume":"19","author":"Segal","year":"1999","journal-title":"J Pediatr Orthop."},{"issue":"1","key":"bib19-20260909","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1148\/radiology.200.1.8657911","article-title":"Vascularity of the neonatal femoral head: in vivo demonstration with power Doppler US","volume":"200","author":"Bearcroft","year":"1996","journal-title":"Radiology."},{"issue":"4","key":"bib20-20260909","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1097\/MED.0000000000000819","article-title":"MR-based techniques for intracortical vessel visualization and characterization: understanding the impact of microvascular disease on skeletal health","volume":"30","author":"L\u00f6ffler","year":"2023","journal-title":"Curr Opin Endocrinol Diabetes Obes."},{"issue":"1","key":"bib21-20260909","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1097\/BPO.0b013e3181926c40","article-title":"Post-closed reduction perfusion magnetic resonance imaging as a predictor of avascular necrosis in developmental hip dysplasia: a preliminary report","volume":"29","author":"Tiderius","year":"2009","journal-title":"J Pediatr Orthop."},{"issue":"2","key":"bib22-20260909","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s00256-020-03572-z","article-title":"Developmental dysplasia of the hip: can contrast-enhanced MRI predict the development of avascular necrosis following surgery?","volume":"50","author":"Nguyen","year":"2021","journal-title":"Skeletal Radiol."},{"issue":"5","key":"bib23-20260909","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1097\/01241398-199709000-00011","article-title":"Postreduction computed tomography in developmental dislocation of the hip: part II: predictive value for outcome","volume":"17","author":"Smith","year":"1997","journal-title":"J Pediatr Orthop."},{"issue":"5","key":"bib24-20260909","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1007\/s00247-020-04896-7","article-title":"Safety issues related to intravenous contrast agent use in magnetic resonance imaging","volume":"51","author":"Ponrartana","year":"2021","journal-title":"Pediatr Radiol."},{"issue":"4","key":"bib25-20260909","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1097\/01241398-200207000-00011","article-title":"Contrast-enhanced power Doppler imaging: comparison with scintigraphic phases of revascularization of the femoral head in Legg-Calv\u00e9-Perthes disease","volume":"22","author":"Doria","year":"2002","journal-title":"J Pediatr Orthop."},{"issue":"6","key":"bib26-20260909","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.2214\/ajr.180.6.1801731","article-title":"Correlation of contrast-enhanced power Doppler sonography and conventional angiography of abduction-induced hip ischemia in piglets","volume":"180","author":"Barnewolt","year":"2003","journal-title":"AJR Am J Roentgenol."},{"key":"bib27-20260909","article-title":"A novel quantitative approach to evaluate femoral head perfusion by contrast-enhanced ultrasound: A pilot study in infants with developmental dysplasia of the hip","author":"Sultan","year":"2023","journal-title":"IEEE Int Ultrason Symp. 2023 Sep"},{"issue":"2","key":"bib28-20260909","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1002\/jum.15097","article-title":"Intraoperative Contrast-Enhanced Ultrasound Imaging of Femoral Head Perfusion in Developmental Dysplasia of the Hip: A Feasibility Study","volume":"39","author":"Back","year":"2020","journal-title":"J Ultrasound Med."},{"issue":"5","key":"bib29-20260909","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1097\/BPO.0000000000000318","article-title":"Reliability of a New Radiographic Classification for Developmental Dysplasia of the Hip","volume":"35","author":"Narayanan","year":"2015","journal-title":"J Pediatr Orthop."},{"issue":"1","key":"bib30-20260909","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.acra.2008.07.013","article-title":"Delta-projection imaging on contrast-enhanced ultrasound to quantify tumor microvasculature and perfusion","volume":"16","author":"Sehgal","year":"2009","journal-title":"Acad Radiol."},{"issue":"14","key":"bib31-20260909","doi-asserted-by":"crossref","first-page":"717","DOI":"10.5435\/JAAOS-D-22-01218","article-title":"AP Radiographic Assessment of the Pediatric Pelvis for Developmental Dysplasia of the Hip","volume":"31","author":"Edmonds","year":"2023","journal-title":"J Am Acad Orthop Surg."},{"issue":"4","key":"bib32-20260909","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1302\/1863-2548.11.170038","article-title":"An improved method for measuring hip abduction in spica after surgical reduction for developmental dysplasia of the hip","volume":"11","author":"DeFrancesco","year":"2017","journal-title":"J Child Orthop."},{"issue":"5","key":"bib33-20260909","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1097\/BPB.0000000000000606","article-title":"Spica MRI predictors for epiphyseal osteonecrosis after closed reduction treatment of dysplasia of the hip","volume":"28","author":"Haruno","year":"2019","journal-title":"J Pediatr Orthop B."},{"issue":"3","key":"bib34-20260909","doi-asserted-by":"crossref","first-page":"e0248701","DOI":"10.1371\/journal.pone.0248701","article-title":"MRI risk factors for development of avascular necrosis after closed reduction of developmental dysplasia of the hip: Predictive value of contrast-enhanced MRI","volume":"16","author":"Cheon","year":"2021","journal-title":"PLoS One."},{"issue":"4","key":"bib35-20260909","doi-asserted-by":"crossref","first-page":"e335","DOI":"10.1097\/BPO.0000000000002614","article-title":"Comparison of Contrast-enhanced Ultrasound and Contrast-enhanced Magnetic Resonance Imaging in the Assessment of Infant Hip Perfusion and Prediction of Proximal Femoral Growth Disturbance Following Closed and Open Reduction for Developmental Dysplasia of the Hip: A Preliminary Study","volume":"44","author":"Matheney","year":"2024","journal-title":"J Pediatr Orthop."},{"issue":"1","key":"bib36-20260909","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/BPB.0b013e32832fc8ca","article-title":"Ossification of the femoral head at closed reduction for developmental dysplasia of the hip and its influence on the long-term outcome","volume":"19","author":"Cooke","year":"2010","journal-title":"J Pediatr Orthop B."},{"issue":"1","key":"bib37-20260909","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/BPB.0000000000001036","article-title":"Coxa Magna following treatment of developmental dysplasia of the hip: investigation for associated potential factors","volume":"33","author":"Topak","year":"2024","journal-title":"J Pediatr Orthop B."},{"issue":"4","key":"bib38-20260909","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1302\/0301-620X.68B4.3733825","article-title":"Overgrowth of the femur after fracture in childhood. An increased effect in boys","volume":"68","author":"Clement","year":"1986","journal-title":"J Bone Joint Surg Br."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.00863","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:20:06Z","timestamp":1788949206000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.00863"}},"subtitle":["Preliminary Findings from a Prospective Study of Contrast-Enhanced Ultrasound"],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":38,"journal-issue":{"issue":"14","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.25.00863","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]}}}