Biomechanical investigation of pelvic stability in developmental dysplasia of the hip: unilateral salter osteotomy versus one-stage bilateral salter osteotomy

Abstract Background Developmental dysplasia of the hip (DDH) is a common disease in infants and children, and the treatment of bilateral DDH remains controversial. This study aimed to evaluate the stability of one-stage bilateral Salter pelvic osteotomy for bilateral DDH in patients of walking age. Methods In total, nine child cadavers aged 2–6 years were included. A universal mechanical testing machine was used for stability test. We performed two different surgical procedures on the specimens: nine child cadavers underwent unilateral Salter pelvic osteotomy, and six child cadavers were randomly selected to undergo Salter pelvic osteotomy again to simulate one-stage bilateral Salter pelvic osteotomy. The stability of the bilateral sacroiliac joints, local stability of the operation area, ultimate load test, and axial stiffness were evaluated. Results Both unilateral and bilateral Salter osteotomy could destroy the integrity of the pelvic ring and increase the risk of pelvic instability. In this study, compared with unilateral Salter osteotomy, bilateral Salter osteotomy had similar pelvic stability, and there was no significant difference between unilateral and bilateral Salter osteotomy in sacroiliac joint stability ( p > 0.05), local stability ( p = 0.763), ultimate load ( p = 0.328), and axial stiffness ( p = 0.480). Conclusions One-stage bilateral Salter pelvic osteotomy as a potential surgical method is viable and stable for children with bilateral DDH.

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Dega pelvic osteotomy: indications, results and complications

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.180091 ◽

2018 ◽

Vol 12 (4) ◽

pp. 342-348 ◽

Cited By ~ 8

Author(s):

J. Czubak ◽

K. Kowalik ◽

A. Kawalec ◽

M. Kwiatkowska

Keyword(s):

Femoral Head ◽

Open Reduction ◽

Age Groups ◽

Pelvic Osteotomy ◽

Developmental Dysplasia ◽

Femoral Osteotomy ◽

Complication Rates ◽

Level Of Evidence ◽

Significant Difference ◽

Dysplasia Of The Hip

Purpose Developmental dysplasia of the hip (DDH) after walking age is difficult to treat. Dega pelvic osteotomy is combined with open reduction and femoral osteotomy to obtain concentric stable reduction with good coverage of the femoral head. The purpose of this study is to evaluate the use of the Dega osteotomy in the treatment of DDH in two different age groups. Methods A total of 45 patients (52 hips) with a mean age of 3.9 years (1.2 to 12.8) were treated with open reduction, Dega osteotomy and femoral osteotomy. There were 38 dislocated and 14 subluxated hips. Bilateral DDH was observed in seven female patients. Radiographic parameters included acetabular index, centre-edge angle of Wiberg and migration percentage. The final radiographic outcome was evaluated according to the Severin classification. Results The mean follow-up period was four years (3 to 9). According to the Severin criteria 78.8% were types I or II whereas 21.2% showed types III or IV. There was no statistically significant difference in final outcome between children less than three years of age and older children at the time of surgery. One hip in children with unilateral involvement had developed coxa magna, that interfered with hip concentricity. Three hips (5.8%) showed avascular necrosis of the femoral head. Conclusion Dega osteotomy is a safe and adequate procedure for the management of developmental dysplasia of the hip in walking patients with low complication rates. Restoring the acetabulum to normal or nearly normal can result in good medium-term results. Level of Evidence III

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Comparison of Pemberton Osteotomy and Kalamchi Modification of Salter Osteotomy in the Treatment of Developmental Dysplasia of the Hip

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.7.4.727.1 ◽

2020 ◽

Vol 7 (4) ◽

pp. 169-174

Author(s):

Kaveh Gharanizadeh ◽

◽

Abolfazl Bagherifard ◽

Mansour Abolghasemian ◽

Hamedreza Ahmadizadeh ◽

...

Keyword(s):

Avascular Necrosis ◽

Pelvic Osteotomy ◽

Study Groups ◽

Clinical Results ◽

Developmental Dysplasia ◽

Acetabular Index ◽

Clinical Criteria ◽

Salter Osteotomy ◽

Characteristic Features ◽

Dysplasia Of The Hip

Background: Several pelvic osteotomy techniques are introduced for the treatment of Developmental Dysplasia of the Hip (DDH). However, there is no agreement on the optimal pelvic osteotomy in DDH. Thus, this study aimed to compare the outcomes of Pemberton Osteotomy (PO) and the Kalamchi Modification of Salter Osteotomy (KMSO). Objectives: Comparison of pemberton osteotomy and kalamchi modification of salter osteotomy in the treatment of developmental dysplasia of the hip. Methods: In a retrospective study, radiographic and clinical outcomes as well as surgical complications were compared between the patients who underwent unilateral DDH surgery using either KMSO or PO. The radiographic measures included the assessment of the acetabular index and the Shenton line. The clinical results of the osteotomies were evaluated by McKay’s criteria modified by Berkeley et al. Also, Kalamchi and MacEwen’s classification was used for the assessment of avascular necrosis. Results: The characteristic features of the patients, such as age and follow-up time, were statistically comparable between the two study groups. One year after the surgery, the Shenton line was intact in 55 patients (84.6%) of the KMSO group and 40 patients (88.9%) of the PO group (P=0.52). The Mean±SD value of the acetabular index was 21.1±5.1 and 20.7±3.9 in the KMSO and PO groups, respectively (P=0.13). Besides, the McKay’s clinical criteria were respectively excellent, good, and fair in 44, 16, and 5 patients (67.7%, 24.6%, and 7.7%, respectively) of the KMSO group, and 31, 12, and 2 patients (70%, 26.6%, and 4.4%, respectively) of the PO group (P=0.4). Moreover, the number of postoperative avascular necrosis did not significantly differ between the two study groups. Conclusion: The PO and KMSO techniques are equally safe and effective osteotomies in the treatment of DDH and can be used interchangeably.

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Biomechanical investigation of pelvic stability in developmental dysplasia of the hip: unilateral salter osteotomy versus one-stage bilateral salter osteotomy

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01683-w ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Lang Li ◽

Xiaodong Yang ◽

Bo Song ◽

Jun Jiang ◽

Lei Yang ◽

...

Keyword(s):

Developmental Dysplasia ◽

One Stage ◽

Salter Osteotomy ◽

Biomechanical Investigation ◽

Dysplasia Of The Hip

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Evaluation of late redislocation in patients who underwent open reduction and pelvic osteotomy as treament for developmental dysplasia of the hip

Hip International ◽

10.5301/hipint.5000571 ◽

2017 ◽

Vol 28 (3) ◽

pp. 309-314 ◽

Cited By ~ 3

Author(s):

Ümit Tuhanioğlu ◽

Hakan Cicek ◽

Hasan U Ogur ◽

Firat Seyfettinoglu ◽

Ahmet Kapukaya

Keyword(s):

Femoral Head ◽

Revision Surgery ◽

Pelvic Osteotomy ◽

Developmental Dysplasia ◽

Primary Surgery ◽

Initial Surgery ◽

Loss Of Reduction ◽

Significant Difference ◽

Hip Spica Cast ◽

Dysplasia Of The Hip

Introduction: The goal in the treatment of developmental dysplasia of the hip (DDH) is to achieve a stable and concentric reduction and to create a congruent relationship between the femoral head and the acetabulum. This study discusses the causes of loss of reduction in DDH patients who had a concentrically reduced hip at the time of removal of the hip spica cast and cessation of brace use and who later appeared with hip redislocation after mobilisation and ambulation. In addition, the possible interventions in such cases are also discussed. Material and method: A retrospective evaluation was made of 13 patients diagnosed with DDH who developed redislocation following primary surgery. 6 of them had undergone the 1st surgery in our department between 2008 and 2016 and 7 had udergone surgery in another centre. For comparison reasons a 2nd group was formed of 13 demographically and clinically matched patients who had no loss of reduction. The groups were compared in terms of acetabular index, pelvic length, pelvic width, abduction degree of plaster, ossifying nucleus diameter, acetabular depth, and acetabular volume parameters. Results: The average age of the patients was 23 months at initial surgery and 29 months at the time of revision surgery. No significant difference was found between the groups in terms of acetabular inclination angle, ossifying nucleus diameter, pelvic size, pelvic width, centre edge angle, acetabular volume, and depth. Contracted inferomedial capsule was found in 1 patient who underwent revision surgery and intact transverse acetabular ligament was seen in 1 patient. The loss of reduction in the remaining 11 patients was associated with high total anteversion of the femoral head and acetabulum. Conclusions: Correction of increased combined anteversion by femoral osteotomy can create a safe zone in terms of redislocation and can significantly contribute to the stability provided by capsulorrhaphy and pelvic osteotomy.

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