Appropriate Surgical Timing of Salter Innominate Osteotomy for Residual Acetabular Dysplasia in Children

Abstract

Background: Salter innominate osteotomy (SIO) provides favorable results for treating residual acetabular dysplasia in young children. In this study, we examined the midterm results of SIO according to the age at surgery to determine the optimal timing of this procedure. Methods: We retrospectively examined 50 hips of 42 patients (8 boys and 34 girls) with acetabular dysplasia who underwent SIO and were followed up until skeletal maturity. The centeredge angle (CEA) was measured based on the anteroposterior radiographs of the hip obtained before surgery, 5 weeks after surgery, and at the latest follow-up. Severin classification was evaluated at the latest follow-up. Patients were categorized into 3 groups according to age at surgery: younger than 7 years of age (group A), 7 to 8 years of age (group B), and 9 years of age or older (group C). Results:The mean preoperative CEA level of 0.9 degrees improved to 17.1 degrees postoperatively, which was increased to 28.1 degrees at the latest examination. Overall, 45 hips (90%) were classified as Severin I or II, with 96% in group A, 94% in group B, and 57% in group C. In group C, postoperative acetabular coverage was similar to that in the other groups (16.6 degrees in group A, 14.8 degrees in group B, and 18.1 degrees in group C), although the final outcome was unsatisfactory. The average improvement in CEA from postoperative to skeletal maturity was significantly smaller in group C than in the other groups (12.7 degrees in group A, 11.3 degrees in group B, and 3.0 degrees in group C). Conclusions: SIO showed favorable outcomes with satisfactory acetabular coverage at skeletal maturity. However, satisfactory acetabular coverage could not be obtained in some older patients because of limited postoperative remodeling capacity and smaller secondary improvement of CEA. We recommend that SIO should be performed in patients aged 8 years or younger.

Predictive Factors for Requiring Salter Osteotomy in DDH

“…Primary approach to DDH remains controversial between 18 to 24 months. [9] Majority of DDH cases are females, approximately 75%-82% of all DDH cases in recent studies [8,14,16]. Moreover, Gurger et al found all their cases to be female [15].…”

“…In different studies, DDH has been treated in a wide age range from 10 months to 11.4 years. [11][12][13][14] Between 6 to 18 months, CR is the treatment choice and OR is only performed in unsuccessful CRs. Pelvic osteotomy is generally used in over 24 months cases.…”

“…Pelvic osteotomy such as SO induced higher AI decrease, and significant radiological improvements, compared to OR. [15,21] pelvic osteotomy usually induces an AI decrease of 11°-22.5° Post-operatively [12,15,22,23,11,14], regardless of age. Although, after SO, AI decreased 18.8° and 16.6° in under and over 3 years old cases respectively, so it was more improved in younger patients, but it was not statistically significant.…”

Effects of different pelvic osteotomies on acetabular morphology in developmental dysplasia of hip in children

“…Salter osteotomy is a classic method of pelvic osteotomy, which belongs to the osteotomies that change the direction of the acetabulum. It was first proposed by Salter in 1961[ 52 ]. The osteotomy line of Salter is from the anterior inferior iliac spine to the great ischial notch, and the entire acetabulum is turned forward and outward with the pubic symphysis as the fulcrum.…”

“…It changes the overall orientation of the acetabulum to increase the inclusiveness of the acetabulum to the femoral head, and the shape and volume of the acetabulum remain unchanged[ 3 ]. Therefore, Salter osteotomy is suitable for the following[ 52 , 53 ]: (1) Children aged 18 mo to 6 years with unossified pubic symphysis; (2) anterolateral acetabular defect as the main defect; and (3) AI is basically normal. Salter osteotomy requires internal fixation support, so the wedge-shaped bone removed from the ilium is placed into the fracture line and fixed with Kirschner wire to increase stability of the acetabulum after osteotomy.…”