Letters to the Editor   |    
T.F. Roush, S.A. Olson, R. Pietrobon, L. Braga, and J.R. Urbaniak reply:
Thomas F. Roush, MD; Steven A. Olson, MD; Ricardo Pietrobon, MD; Larissa Braga, MD; James R. Urbaniak, MD
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These letters originally appeared, in slightly different form, on jbjs.org. They are still available on the web site in conjunction with the article to which they refer.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Feb 01;89(2):449-450
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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.
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