Comparison of Salter osteotomy and Tonnis lateral acetabuloplasty with simultaneous open reduction for the treatment of developmental dysplasia of the hip: midterm results

Salter osteotomy has lower fluoroscopy exposure time compared to Tonnis lateral acetabuloplasty

Salter osteotomy and Tonnis lateral acetabuloplasty (TLA) are pelvic osteotomies with similar indications and clinical results used in the treatment of developmental dysplasia of the hip (DDH). The aim of our study was to compare the intraoperative fluoroscopy exposure time (FET) in patients with DDH treated with the Salter osteotomy and TLA. In this study, data were collected prospectively and compared after the study was completed. The patients were evaluated in three groups: pelvic osteotomy (group 1), open reduction with pelvic osteotomy (group 2) and open reduction + pelvic osteotomy + femoral shortening (group 3). Pelvic osteotomy techniques in each group were further analyzed in two subgroups as Salter osteotomy and TLA. Age, sex, surgery side, degree of dysplasia according to the Tönnis classification, duration of anesthesia and intraoperative FET (seconds) were recorded. A total of 109 patients (93 girls and 16 boys) were included in the study; 29 patients in group 1, 50 in group 2 and 30 in group 3. Although the patients who underwent Salter osteotomy and TLA were similar in all three groups in terms of age, sex, surgery side, Tönnis classification and duration of anesthesia, FET was longer in the patients who underwent TLA (group 1, P  < 0.001; group 2, P  < 0.001; group 3, P  = 0.005). The use of the Salter osteotomy technique in the treatment of acetabular dysplasia in patients with DDH seems to be more advantageous in terms of FET than TLA osteotomy. It would be beneficial to consider this result in terms of radiation safety. Level of Evidence: II.

MODIFIED SALTER PELVIC OSTEOTOMY FOR THE DDH TREATMENT

Objectives

Three pelvic osteotomies (Salter, Dega, Pemberton) are widely used in walking patients under seven years old for DDH treatment. We've proposed a modified Salter Pelvic Osteotomy (SPO), which has the advantages of the abovementioned osteotomies.

Methods

Short- and mid-term results were assessed in 19 patients after the modified SPO application. Patients were examined before and after the surgery, at 6 months postoperatively, and at follow-up.

Results

Acetabular Index (AI) before the surgery was 39.5 ± 7 °; after the surgery - 24.4 ± 5.5 °, at 6 months - 20.4 ± 5 ° (9-28), at follow-up - 14.5 ± 4 °; AI correction - 14.9 ± 5.5 °. Lateral Centre-Edge Angle at follow-up - 22.7 ± 4.7 °. Clinical results at follow-up were I / II McKay grade in 18 patients (94.7%); radiological results were I / II Severin class in 18 patients (94.7%).

Conclusion

Modified SPO improves the FH coverage in any direction; results after modified SPO are excellent and good in most patients. Level of Evidence IV; Case Series .

Modified Pemberton Pelvic Osteotomy Through Inner Ilium Approach for Treatment of Developmental Dysplasia of the Hip in Children

INTRODUCTION

Pemberton osteotomy is a widely used operation in developmental dysplasia of the hip (DDH). The traditional pelvic osteotomy was through outside of the ilium. However, in this study, we performed the pelvic osteotomy through the inner ilium approach.

PATIENTS AND METHODS

We retrospectively analyzed 79 patients diagnosed with DDH with open surgery in our hospital from March 2016 to May 2018. There were 39 patients who underwent outside ilium Pemberton osteotomy (PO) and 40 patients who underwent inner "L shaped" ilium Pemberton osteotomy (ILSO). Acetabular index (AI), center-edge angle of Wiberg (CE angle), Severin grading scoring system, postoperative avascular necrosis (AVN) by Kalamchi and McEwen classification, and McKay grading scoring system were used for evaluation.

RESULTS

There was no significant difference between the PO group and ILSO group on AI (p = 0.476), CE angles (p = 0.225), avascular necrosis (Kalamchi and McEwen, p = 0.854), and hip function (McKay's, p = 0.444) on the final follow-up. There were significant differences in X-ray radiation (p < 0.001), blood loss (p = 0.011) and surgery time (p < 0.001).

CONCLUSION

Inner side ilium is a viable approach for Pemberton osteotomy of DDH in children with less X-ray radiation, and less blood loss and shorter surgery time.

LEVEL OF EVIDENCE

III.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43465-022-00676-7.

Salter pelvic osteotomy for the treatment of Developmental Dysplasia of the Hip: assessment of postoperative results and risk factors

BACKGROUND

If non-surgical treatment of Developmental Dysplasia of the Hip (DDH) fails or if DDH is late-detected, surgery is necessary. Salter pelvic osteotomy (SPO) is an effective surgical option for such cases.

OBJECTIVES

To study the results after SPO; to evaluate risk factors; to reveal radiological parameters that may correlate with results.

METHODS

Results analysis in 17 patients (22 hips). Risk factors included those that do not depend on the surgeon (patient's age, value of the acetabular index (AI) preoperatively, DDH Tonnis grade) and those that depend on the surgeon (amount of AI correction). To radiological parameters which may correlate with the amount of AI correction we referred distance "d" and the lateral rotation angle.

RESULTS

SPO allows performing AI correction in ranges 24.1 ± 6.5°. Excellent and good clinical results were obtained in 95.5% of patients; excellent and good radiological results in 86.4% of patients. Risk factors that do not depend on the surgeon were older patient's age and higher preoperative AI values (p <0.05). The risk factor that depends on the surgeon was the amount of AI correction (p <0.05). The distance "d" was recognized as a radiological parameter that may indicate sufficient AI correction (p <0.05).

CONCLUSION

In older patients with a higher preoperative AI value the results will be predictably worse. The surgeon may influence the result with a greater amount of AI correction (which may also be indicated radiologically by the distance "d" values).

LEVEL OF EVIDENCE

IV, therapeutic, case series.

Mid- and long-term outcome of Salter's, Pemberton's and Dega's osteotomy for treatment of developmental dysplasia of the hip: a systematic review and meta-analysis

INTRODUCTION

Early diagnosis and early treatment have become the gold standard for management of developmental dysplasia of the hip. Surgery is required in case of failed initial treatment. Innominate pelvic osteotomy of Salter (SIO), Pemberton's pericapsular osteotomy (PPO) and Dega's acetabuloplasty (DA) are among the most used procedures.We performed a systematic review and meta-analysis of the past 57 years in order to assess the mid- and long-term outcome of these techniques.

METHODS

Studies met inclusion criteria if they: (1) reported at least 5 cases treated by 1 of the abovementioned surgical techniques; (2) included children aged between 1 and 8 years; (3) surgical indication was late detected DDH or a failed initial treatment; (4) presented a minimal follow-up of 24 months; (5) reported the radiological score of Severin and/or the clinical score of McKay.Clinical and radiological outcomes were dichotomised into favourable and unfavourable outcome and weighted summary rates were determined using meta-analysis models.

RESULTS

From a total of 7391 articles, 48 level of evidence grade IV articles were included in our review. A total of 2143 cases with a mean follow up of 112.4 months were included.Pooled Severin score indicated a statistically better outcome for PPO and DA compared to SIO (p = 0.0003 and p = 0.002, respectively). By dichotomising the results in favourable and unfavourable outcome, PPO showed the best results (p = 0.0002 vs. SIO, p = 0.01 vs. DA).Pooled McKay score showed a statistically better outcome for PPO and DA compared to SIO (p < 0.0001 and p = 0.03, respectively) as well as better outcomes for PPO compared to DA (p = 0.01). By dichotomising the results in favourable and unfavourable, PPO showed the best results.

CONCLUSIONS

Even if our review demonstrates slightly better radiological and clinical results with the PPO, the currently available and limited data do not allow for clear recommendation towards one of these techniques.

Comparison of the inner side and two-sided approaches for iliac crest bone graft harvesting for pediatric pelvic osteotomy

Background

The iliac crest is one of the most used bone graft sources. In this study, we aimed to identify the effects of inner side and two-sided approaches for iliac crest bone harvesting on post-surgery ilium growth in children.

Materials and methods

We retrospectively analyzed 47 patients who underwent pelvic osteotomy and iliac crest bone graft (ICBG) procedures from January 2015 to September 2018. The patients were divided into an inner table ilium exposure group (group A) and the inner-outer table ilium exposure group (group B) and were followed up with radiography in postoperative months 1, 3, 6, and 12, and the growth areas were measured using PACS software. Complications such as damage to the arteries or nerves, ureteral injury, gastrointestinal hernia, ileus, abnormal cosmetic appearance, sensory disturbances, and functional limitations were recorded based on clinical records.

Results

There were 22 patients aged 5.3±1.5 years in group A and 25 patients aged 5.9±1.8 years in group B. There were no significant differences in demographics between the two groups, or in growth in the first month. However, bone graft growth at months 3, 6, and 12 was significantly better in group A than in group B. There was no significant difference in complications between the two groups.

Conclusion

Exposure of only the inner table of the ilium resulted in faster recovery of the bone defect than two-sided exposure in pelvic osteotomy. Therefore, we suggest protecting the outer side of the ilium during surgery.

Level of evidence

Level III

Outcomes and complications of patients undergoing Salter's innominate osteotomies for hip dysplasia: a systematic review of comparative studies

The purpose of this systematic review is to assess outcomes and complications of patients undergoing Salter's innominate osteotomies (SIOs) for the correction of hip dysplasia along with patient and technical factors that can be optimized to improve outcomes after SIO. MEDLINE and EMBASE were searched from data inception to 9 October 2018. Data were presented descriptively. Twenty-seven studies were identified including 1818 hips (87.1%) treated with SIO (mean age of 2.1 ± 2.5 years and mean follow-up of 3.5 ± 5.0 years). Patients undergoing SIO had a post-operative center-edge angle (CEA) of 31.3° ± 5.3° and an acetabular index (AI) angle of 16.1° ± 5.2°. Patients undergoing SIO with pre-operative traction had significantly lower (P = 0.049) post-operative McKay criteria scores compared to patients without pre-operative traction. Patients undergoing SIO between the ages of 1.5-2 years had significantly better (P < 0.05) post-operative McKay criteria scores compared to patients aged 4-6 years. The complication rate was 9.4% with avascular necrosis (2.5%) being most common. This review found that SIO for developmental dysplasia of the hip produces generally good post-operative clinical outcomes. The CEA and AI can be corrected to normal range after SIO. Patients may have superior outcomes if they have SIO at a younger age, were not treated with pre-operative traction and did not have untreated contralateral hip dysplasia. Outcomes appear to be similar between one-stage bilateral SIO and a two-stage procedure in the setting of bilateral hip dysplasia; however, more multicentered studies are needed to confirm these results.

Pelvic Osteotomies in the Child and Young Adult Hip: Indications and Surgical Technique

Pelvic osteotomies are used for hip preservation in children and young adults to improve femoral head coverage and stabilize the hip joint. Redirectional osteotomies aim to reduce the overall volume and redirect the acetabulum. These include Salter, Pemberton, Dega, and San Diego osteotomies. Reorientation osteotomies aim to reorient the acetabulum and include periacetabular and triple osteotomies. Salvage osteotomies aim to enlarge the acetabulum and medialize the hip center. These include shelf and Chiari osteotomies. The standard anterior approach and surgical technique for the eight pelvic osteotomies used by hip preservation surgeons are described along with each osteotomy's history, indications, and outcomes.