A Newly Modified Salter Osteotomy Technique for Treatment of Developmental Dysplasia of Hip That Is Associated with Decrease in Pressure on Femoral Head and Triradiate Cartilage

Abstract

Background and Purpose. The Salter innominate osteotomy has been an effective method to treat the developmental dysplasia of hip (DDH) over the past decades; however, several postoperative complications and deficiencies were reported. In this study, we evaluated outcome of a newly modified Salter osteotomy in patients presenting with DDH. Methods. We reviewed retrospectively 76 patients (90 hips) with DDH aged ≥ 18 months, who underwent open reduction and a modified osteotomy by a single surgeon. The distal osteotomy segment of pelvis was shifted anterolaterally in the amount of osteotomy cross-section, but not downwards. The mean age at surgery was 2 years and 11 months (1.5 to 16 years). Femoral shortening was conducted when necessary. The duration of operation varied between 60 and 90 minutes. The mean follow-up was 4 years and one month (range 15 months to 7 years and 9 months). All patients were followed up both clinically (based on the modified MacKay criteria) and radiologically (based on the modified Severin criteria). Results. Clinically, 94.5% of hips had excellent and good results at final follow-up, and only 5.5% had a fair condition. Radiographically, at the final follow-up 77.8% of hips were grade IA (excellent), 12.2% were grade IB, 6.7% were grade II, and 3.3% were grade III (fair). The preoperative mean acetabular index was 47.85° (41° to 59), which decreased to 17.16° (13° to 22°) immediately after the surgery (p<0.0001) and progressed to 11.24° (7° to 19°) at the final follow-up (p<0.0001). The mean initial postoperative center-edge angle was 30.3° (25° to 42°) significantly improved to 39.1 (31° to 56°) at the final follow-up (p<0.0001). Avascular necrosis of femoral head occurred in 4.4% of hips (4 patients). Conclusion. The results show that our modified Salter osteotomy is safe and associated with significant benefit for the management of patients suffering from DDH.

Universal Digital Model of a Child's Pelvis

“…Виправлення деформації вертлюжної западини під час остеотомій таза відбувається за рахунок реорієнтації дистального фрагмента клубової кістки; під час такої реорієнтації спостерігаються пластичні зміни у так званих шарнірних точках. Різні шарнірні точки описані в літературі під час виконання вказаних вище остеотомій таза [9][10][11][12]. Кількість і розташування шарнірних точок є важливими для хірурга з погляду їх можливого пошкодження під час операції та можливості комбінації різних остеотомій таза з двох сторін одночасно.…”

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

“…Developmental Dysplasia of the Hip (DDH) is the commonest hip joint pathology in neonates. 1 According to the natural history, DDH leads to early hip arthritis. 2 If DDH is detected in non-walking patients, non-surgical treatment (using abduction braces) is highly effective.…”

“…2 If DDH is detected in non-walking patients, non-surgical treatment (using abduction braces) is highly effective. 1 However, even after the succesful femoral head concentric reduction, residual acetabular dysplasia will occur in 26% of patients. 3 Moreover, in older patients (who started to walk), concentric reduction of the femoral head is difficult to achieve with non-surgical methods due to the adaptive contracture of the surrounding muscles and hypertrophy of intra-articular structures; 66% of these patients will further require surgery.…”

“…4 Thus, surgical treatment is mandatory for residual acetabular dysplasia after failed non-surgical treatment and for late-detected DDH. [1][2][3][4] There are different surgical options for DDH treatment: isolated femoral head open reduction, femoral varus derotational osteotomy (FVDO), different pelvic osteotomies, and the combination of all aforementioned procedures (single-stage surgery -SSS). 2,4 However, better results were detected after pelvic osteotomies or SSS.…”

Improving the cosmetic outcome of Salter osteotomy through the modification of iliac crest graft harvesting site: a pilot clinical study

“…Even so, this procedure is not without complications and several modifications have been made over the years to address these limitations. [6][7][8] While the majority of earlier modifications have focused on the optimization of the stability aspects of the Salter osteotomy, a new interest has been devoted to reducing the morbidity of iliac crest graft harvesting in the Salter osteotomy. 9,10 The conventional graft harvesting site in a Salter osteotomy impairs the symmetry of the hip through alteration in the reference point of anterior superior iliac spine (ASIS).…”