Open reduction and Salter innominate osteotomy combined with femoral osteotomy in the treatment of developmental dysplasia of the hip: Comparison of results before and after the age of 4 years

Köroğlu, Cenk; Özdemir, Emre; Çolak, Mehmet; Şensöz, Ersin; Öztuna, Fehmi Volkan

doi:10.5152/j.aott.2021.17385

Cited by 5 publications

(7 citation statements)

References 19 publications

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“…Although, groups I and II had similar satisfactory results, group III had statistically significantly poor results. Thus, we found that the clinical results were significantly poorer in group III, which included patients older than six years as observed by other studies [5,13,16,17].…”

Section: Discussionsupporting

confidence: 85%

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The effect of patient’s age on the outcomes of Salter pelvic osteotomy

İnci¹,

Bulut

Gümüştaş

2021

Marmara Medical Journal

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Objective: We hypothesized that as the patient's age increases, the outcomes of Salter pelvic osteotomy (SPO) get worse. This study aims to compare the results of surgery in developmental dysplasia of the hip (DDH) with at which age SPO is performed.Patients and Materials: Forthy six hips of 36 patients with at least 1 year of regular radiological and clinical follow-up were included in this study. The patients were retrospectively divided into three groups, group I for ages between 18 months and 4 years, group II for ages between 4 and 6 years, and group III for ages over 6 years. The clinical and radiological results of the patients were compared between groups.Results: At the time of surgery, the mean age of patients was 4.51 years (18 months-11 years). After a mean follow-up of 72.7 months; although there was no statistically significant difference between groups according to Severin's radiological criteria, it was observed that the success of the clinical outcome decreased and the avascular necrosis (AVN) rates increased in children who were operated after the age of 6 years. Conclusions: Although, SPO was an effective treatment option for patients with DDH after the age of walking, it might cause a decrease in the success of clinical outcomes and an increase in AVN after 6 years of age.

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Section: Discussionsupporting

confidence: 85%

“…In this study, the average correction of the CEA (9 degrees) and the AI (5 degrees) obtained by the Salter innominate osteotomy (SIO) were within the range of correction reported in most studies [8,13,[17][18][19].…”

Section: Discussionsupporting

confidence: 81%

The effect of patient’s age on the outcomes of Salter pelvic osteotomy

İnci¹,

Bulut

Gümüştaş

2021

Marmara Medical Journal

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“…В настоящее время в мировых научных базах данных представлены многочисленные публикации, доказывающие высокую эффективность коррекции ацетабулярной дисплазии у детей младшего возраста с различной степенью тяжести нестабильности тазобедренного сустава диспластического генеза путем выполнения различных модификаций остеотомии таза по Salter, перикапсулярной ацетабулопластики по Pemberton, а также их комбинации (Pembersal), ацетабулопластик по Dega и San Diego [32][33][34][35][36]. Однако суть подавляющего большинства этих работ сводится к анализу результатов путем сравнения величины коррекции АИ или эффективности используемых методик в целом, а диагностику рентген-анатомического состояния тазобедренного сустава проводят по существующим международным классификациям, которые отражают только степень нарушения соотношений между проксимальным эпифизом бедренной кости и вертлужной впадины и не отражают возможного варианта деформации последней [8,9,[37][38][39][40]. К примеру, B. Dello Russo и J.G.…”

Section: Discussionunclassified

“…Perlik [1][2][3][4][5][6]. При этом до настоящего времени выбор остеотомии таза при поздней диагностике дисплазии тазобедренного сустава у детей младшего возраста чаще всего зависит от опыта и предпочтений хирурга [7], а диагностика степени нарушения соотношений основана на общепринятой классификации дисплазии тазобедренных суставов, разработанной D. Tönnis, и ее модификации International Hip Dysplasia Institute (IHDI) [8,9].…”

Section: обоснованиеunclassified

The choice of pelvic osteotomy technique in young children with hip dysplasia

Bortulev

Baskaeva²,

Vissarionov³

et al. 2023

Pediatr Traum Orthop Reconstr Surg

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BACKGROUND: The choice of pelvic osteotomy in young children with late diagnosis of hip dysplasia most often depends on the experience and preferences of the surgeon, and the diagnosis of the degree of violation of the ratios is based on the generally accepted classification of hip dysplasia without considering possible variants of the deformation of the acetabulum. We hypothesized that the choice of the pelvic osteotomy technique in the surgical treatment of children with hip dysplasia of varying severity should be based on the variant of acetabulum deformation and the corrective capabilities of pelvic osteotomy. AIM: This study aimed to compare and analyze the results of the surgical treatment of children with hip dysplasia of varying severity and to evaluate the effectiveness of the proposed differentiated approach to the choice of the pelvic osteotomy technique. MATERIALS AND METHODS: The study included 150 patients (150 hip joints) aged 24 years (3.1 0.45) with grade IIIV hip dysplasia, according to the supplemented classification of Tnnis. Depending on the verified variant of acetabulum deformity and taking into account the corrective capabilities of various osteotomies, we divided the patients into three groups. All patients underwent conventional clinical and X-ray examinations. During radiometry, the following indicators were evaluated: acetabular index (AI), Wiberg angle, neckshaft angle (NSA), anteversion angle of the proximal femur, degree of bone coverage, acetabulum depth (AD) and pelvic height, length of the acetabular arch (LAA), and presence or absence of a bone oriel (BO). RESULTS: In the comparative analysis of the radiographic anatomical condition of the hip joint in children with hip dysplasia of varying severity, the differentiated use of the modified Salter pelvic osteotomy without autograft and pericapsular acetabuloplasty according to Pemberton and Pembersal surgery led to adequate correction of various variants of congenital acetabular deformity with approximately normal anatomy of the acetabulum and not lead to significant deformation of the hemipelvis, such as elongation. CONCLUSIONS: The results of the surgical treatment of young children with hip dysplasia of varying severity according to the proposed differentiated approach to the choice of the pelvic osteotomy technique, which is based on the variant of acetabulum deformation, indicate the achievement of adequate correction of congenital deformity of the acetabular component of the joint with the restoration of its anatomical structure and avoidance of secondary deformation of the hemipelvis. The effectiveness of the proposed approach to the choice of pelvic osteotomy technique in the treatment of young children with hip dysplasia of varying severity is confirmed by the changes in AI, Wiberg angle, AD, and PH, whose values became close to the individual norm (p 0.05), and reduction of possible secondary deformities.

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“…[4][5][6] Femoral and acetabular osteotomies may also be performed at the time of open reduction. [7][8][9][10][11][12][13] Although open reduction has been shown to result in better acetabular remodeling than closed reduction, 14,15 this more extensive treatment has also been associated with significant complications. Notably, there have been several reports of avascular necrosis (AVN) of the femoral head arising from open reduction with studies citing rates ranging from 7% to 36%.…”

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confidence: 99%

Outcomes of Open Reduction in Children With Developmental Hip Dislocation: A Multicenter Experience Over a Decade

Cummings

Oladeji

Rosenfeld

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Open reduction of the hip is commonly performed in children with severe developmental dysplasia of the hip, or in cases that are refractory to nonoperative forms of treatment. The open reduction has been associated with numerous complications including avascular necrosis (AVN) of the femoral head, the need for reoperation, and residual radiographic dysplasia. This study seeks to determine the effects of preoperative severity of dysplasia, associated procedures (femoral and acetabular osteotomies), age on AVN, and the need for reoperation. Methods: Children with developmental dysplasia of the hip and a minimum of 2 years of follow-up who underwent open reduction were identified. The following data points were recorded: sex, laterality of hip involvement, simultaneous procedures, surgical approach used, age, acetabular index, and International Hip Dysplasia Institute grade. We analyzed the effects of preoperative International Hip Dysplasia Institute, age, surgical approach (anterior/medial), bilateral reduction, and simultaneous femoral shortening or pelvic osteotomy on the outcomes of AVN and reoperation. Results: One hundred eighty-five hips in 149 patients were included in this study with an average follow-up of 4 years (range: 2 to 5 y). The average age at index surgery was 23 months (range: 1 to 121 mo). Overall, 60 hips (32.4%) required secondary surgical procedures at an average age of 58.5 months. High-grade AVN was noted in 24 hips (13.0%) and was found to be associated with the severity of the hip dislocation (P = 0.02). A higher rate of reoperation was found in children over 18 months at the time of open reduction who did not receive an acetabular osteotomy (P = 0.012). Conclusion: Approximately 1/3 of patients require another operative intervention within the first 4 years after open reduction of the hip. We found the severity of hip dislocation to be associated with a higher risk of AVN development. These findings support performing an acetabular osteotomy in children over 18 months of age at the time of open reduction to decrease the likelihood of requiring future reoperation during the first 4 years after the index procedure. Level of Evidence: Level III.

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Open reduction and Salter innominate osteotomy combined with femoral osteotomy in the treatment of developmental dysplasia of the hip: Comparison of results before and after the age of 4 years

Cited by 5 publications

References 19 publications

The effect of patient’s age on the outcomes of Salter pelvic osteotomy

The effect of patient’s age on the outcomes of Salter pelvic osteotomy

The choice of pelvic osteotomy technique in young children with hip dysplasia

Outcomes of Open Reduction in Children With Developmental Hip Dislocation: A Multicenter Experience Over a Decade

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