Extract
We appreciate Dr. Brannon's comments and questions. He raises several
necessary points of clarification.First, he correctly emphasizes the limitations of citing the article by
Gregosiewicz and
Wosko4 pertaining to
the causation of osteonecrosis in children with known congenital hip
dislocation. His mention of the discrepancy regarding the age of the patients
in that series and the age of the patients in our report is indeed accurate.
We cited that article to demonstrate the paucity of literature regarding the
relationship between osteonecrosis and developmental dysplasia of the hip. The
primary utility that we found from that article was related to its postulation
that osteonecrosis tended to be more severe in hips with developmental
dysplasia than in those without dysplasia. Clearly, any additional
extrapolation from the article by Gregosiewicz and
Wosko4 would be
inaccurate because of the age and disease differences between their series of
patients and ours. The article by Hadley et
al.8, which was also
cited in our manuscript, was instead a more appropriate validation of our
hypothesis as it emphasized the increased contact stresses on the femoral head
in patients with developmental dysplasia of the hip.