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

Abstract

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.

How Does Initial Surgery Age Affect the Radiological Results of Single-Stage Open Reduction, Femoral Shortening, and Salter’s Osteotomy in Patients Over the Age of Four With Developmental Hip Dysplasia ?

“…The prevalence of AVN in the 4 -8 years group ranges between 3% and 60% (8). In a systemic review of comparative studies, they reported that the complication rate for Salter innominate osteotomy was 9.4% and AVN was the most common complication (23) (27). In our study, AVN of the femoral head was observed in two patients; according to Bucholz and Ogden's classification, one was Type 1 and one was Type 3 AVN.…”

Factors influencing outcomes of pelvic osteotomy for residual acetabular dysplasia following closed reduction in patients with developmental dysplasia of the hip

“…Although satisfactory results can be achieved in most patients after closed reduction and cast immobilization, some patients still develop residual acetabular dysplasia (RAD), which often requires a second surgical treatment [4][5][6][7]. Generally, a pelvic osteotomy according to Salter [8] or Pemberton [9], or a triple pelvic osteotomy [10], is recommended in patients with RAD following closed reduction and spica cast immobilization. Chaker et al and Faciszewski et al have reported good outcomes of pelvic osteotomy in patients with RAD following closed reduction and spica cast immobilization [11,12].…”

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

“…The acetabulum gains greater coverage of the femoral head and a larger weight-bearing area by osteotomy of the ilium and rotational movement of the distal fragment anterolaterally in SIO. Therefore, many surgeons believe that SIO has a limited corrective effect in older patients because of the decreased flexibility of the symphysis pubis and pelvic bones and the decreased ability of bone remodeling 9,10. Consequently, in older children, rotational osteotomies such as triple osteotomy and periacetabular osteotomy are preferred, but these are more invasive and the techniques are more difficult.…”

“…Therefore, many surgeons believe that SIO has a limited corrective effect in older patients because of the decreased flexibility of the symphysis pubis and pelvic bones and the decreased ability of bone remodeling. 9,10 Consequently, in older children, rotational osteotomies such as triple osteotomy and periacetabular osteotomy are preferred, but these are more invasive and the techniques are more difficult. Furthermore, complications such as bleeding, failure of bony union, and loss of fixation are more frequent.…”