Assessment of Acetabular Retroversion following Long Term Review of Salter's Osteotomy

Abstract

Salter's innominate osteotomy may predispose to anterior over-coverage of the acetabulum. Over cover or retroversion has been demonstrated to be a cause of hip pain, impingement and subsequent osteoarthritis. We reviewed the long-term follow up of seventeen skeletally mature hips in sixteen patients who had previously undergone a Salter's osteotomy in childhood. The Salter pelvic osteotomy was performed at a mean average age of 5 years and follow up at a mean average age of 20 years. Patients were assessed by clinical examination for signs of impingement, Harris Hip Score and pelvic radiograph. Acetabular version was evaluated by the relationship between anterior and posterior walls of the acetabulum using templates applied to the pelvic radiograph as described by Hefti. The median acetabular cover averaged 17 degrees of anteversion with 2 patients (12%) demonstrating retroversion, neither of whom, had signs of impingement on examination. The mean average Harris Hip Score was 85 indicating a good outcome at long-term follow-up. We believe acetabular remodelling may occur with age after Salter's innominate osteotomy and have found good results in patients after skeletal maturation. Fears of long-term anterior over-coverage and retroversion with this operation may be unfounded.

Comparison of Acetabular Anterior Coverage After Salter Osteotomy and Pemberton Acetabuloplasty: A Long-term Followup

“…They may have more remodeling potential. Compatible with other studies [1,10], the change in anterior acetabular coverage in the Salter group in our study was not significant after an average of 22 years of followup. For the Pemberton group, we cannot conclude that remodeling continues and the weightbearing zone acetabular index would be restored after a longer followup.…”

“…Only several studies have focused on the correction after a Salter osteotomy in the sagittal plane, acetabular version, and anterior coverage [1,3,10,12]. To our knowledge, there has been no study regarding the change in the sagittal plane after a Pemberton acetabuloplasty.…”

“…We think the results of the 42 patients who completed their followups could represent the clinical course for patients in each group. Robb et al [10] measured acetabular retroversion of 17 skeletally mature hips after Salter osteotomies. Only two (12%) showed retroversion and they believed that acetabular remodeling might occur after the Salter osteotomy.…”

“…They suggested that performing the Salter osteotomy before the patient is 5 years old did not consistently cause acetabular retroversion that persisted to adulthood. Among the four studies [1,3,10,12] regarding anterior acetabular coverage after Salter osteotomy, the two studies reporting a remodeling effect were those with longer followups (Table 4). Our patients underwent surgeries when they were between 12 to 36 months old, which is younger than patients in other studies [1,3,10,12].…”

“…Adequate containment and a stable hip allow weightbearing and osseous remodeling of the dysplastic acetabulum. Concerns have been raised that redirection of the acetabulum with the Salter osteotomy may create or increase retroversion or anterior overcoverage [1,3,10,12]. To our knowledge, there has been no study of the change of acetabular version or anterior coverage after a Pemberton acetabuloplasty.…”