The shelf operation for hip dysplasia in adolescence

Abstract

Failure of normal acetabular development is inevitable in congenital dislocation of the hip when it is unrecognised until late infancy or early childhood. Numerous stabilising procedures have been described, one of the first being the shelf operation or acetabuloplasty. This procedure fell into disrepute because the shelf was often located too high or was too small to prevent upward migration of the femoral head. The technique described emphasises the importance of resecting the thickened capsule and exposing the lateral margin of the acetabulum to allow a substantial portion of the outer cortex of the ilium to be turned down both laterally and anteriorly over the femoral head. Twenty cases of acetabuloplasty have been followed up for an average period of nine years. The results have been assessed from the point of view of function, relief of pain, and degree of support of the femoral head as demonstrated radiologically. The shelf operation is a simple and safe procedure, and provided it gives adequate support to the subluxated femoral head it will ensure a stable, mobile joint capable of standing up to reasonable use for many years. If deterioration should occur in later life, total hip replacement may be undertaken more easily than if the joint had been allowed to undergo progressive subluxation.

Long-term results after closed reduction of latedetected hip dislocation: 60 patients followed up to skeletal maturity

“…Good results in 60-85% of cases after relatively short follow-up have been reported (Bjøro 1956, Wilson 1974, Wainwright 1976) but there seems to be a gradual failure of the operation with time. Summers et al (1988) had a mean follow-up of 16 years and found good results in 59% of cases, which is consistent with the good effect in 10 of the 14 hips in this study.…”

Treatment of Adolescents with a Periacetabular Osteotomy After Previous Pelvic Surgery

“…Various surgical procedures, including the Salter, Pemberton, Steel, and Tönnis osteotomies and shelf acetabuloplasty, have addressed the different pathologic components of the dysplastic hip. However, their success rates based on radiographs and self-reported patient outcomes have been variable [8,16,26,32,33,39,43,44,46] and the choice for the optimal surgical procedure to correct acetabular dysplasia continues to be controversial.…”

Non-destructive biomechanical analysis to evaluate surgical planning for hip joint diseases

“…The shelf operation has been a major surgical option in children over 8 years old to provide adequate support to the subluxated femoral head and ensure a stable mobile joint capable of standing. [2][3][4][5] It is necessary to provide the biomechanical guideline for optimal surgical parameters of the shelf surgery.…”