The Outcome of Salter Innominate Osteotomy for Developmental Hip Dysplasia before and after 3 Years Old

Document Type : RESEARCH PAPER

Authors

Joint Reconstruction Research Center, Tehran University of Medical Science, Tehran, Iran

Abstract

Background: Developmental dysplasia of the hip (DDH) is one of the most important and challenging conditions in
the field of pediatric orthopedics; if not diagnosed and treated in time, it would lead to remarkable morbidity. Methods
of treatment based on the patient’s age can vary. The aim of this study is to compare the outcomes of Salter osteotomy
surgery in two groups of patients under and over three years old.
Methods: In this retrospective study, medical records of patients who had undergone innominate Salter osteotomy,
within the past ten years, due to non-pathological DDH were collected. Mean follow up of all patients is 70.28 months
(min=25, max=118).
Results: seventy patients were selected including 85 operated hips. Radiological satisfaction based on modified
Severin score system rate was 86% and 85% for lower three years old group and second group, respectively. In clinical
assessment, it was found that results in 82% of the patients under 3 years old and 82.9% of patients older than three
years old were satisfactory. There was no statistically significant difference between the two groups based on Modified
MacKay criterion.
Conclusion: Results in both groups of patients under and over 3 years old were found satisfactory. Difference in
patient satisfaction rates based on clinical and radiological outcomes was not statistically significant between the
two groups. It should also be noted that complications such as redislocation and deep wound infection would cause
poor clinical and radiological outcomes.

Keywords

Main Subjects


1. Novacheck TF. Developmental dysplasia of the hip.
Pediatr Clin North Am. 1996; 43(4):829-48.
2. Dezateux C, Rosendahl K. Developmental dysplasia of
the hip. Lancet. 2007; 369(9572):1541-52.
3. Suzuki S. Deformity of the pelvis in developmental
dysplasia of the hip: three-dimensional evaluation by
means of magnetic resonance image. J Pediatr Orthop.
1995; 15(6):812-6.
4. Altay M, Demirkale I, Senturk F, Firat A, Kapicioglu S.
Results of medial open reduction of developmental
dysplasia of the hip with regard to walking age. J
Pediatr Orthop Part B. 2013; 22(1):36-41.
5. Vafaee AR, Baghdadi T, Baghdadi A, Jamnani RK. DDH
epidemiology revisited: do we need new strategies?
Arch Bone Jt Surg. 2017; 5(6):440.
6. Graf R. Is DDH still a problem? Arch Bone Jt Surg.
2014; 2(1):2-3.
7. Feldman DS. How to avoid missing congenital
dislocation of the hip. Lancet. 1999; 354(9189):
1490-1.
8. Ryan MG, Johnson LO, Quanbeck DS, Minkowitz B.
One-stage treatment of congenital dislocation of the
hip in children three to ten years old. Functional and
radiographic results. J Bone Joint Surg Am. 1998;
80(3):336-44.
9. Abdullah ES, Razzak MY, Hussein HT, El-Adwar KL,
Abdel-Razek Youssef A. Evaluation of the results
of operative treatment of hip dysplasia in children
after the walking age. Alexandria J Med. 2012;
48(2):115-22.
10. Terjesen T. Dysplasia of the contralateral hip in
patients with unilateral late-detected congenital
dislocation of the hip: 50 years’ follow-up of 48
patients. Bone Joint J. 2014; 96(9):1161-6.
11. Kothari A, Grammatopoulos G, Hopewell S, Theologis
T. How does bony surgery affect results of anterior
open reduction in walking-age children with
developmental hip dysplasia? Clin Orthop Relat Res.
2016; 474(5):1199-208.
12. Mardam-Bey TH, MacEwen GD. Congenital hip
dislocation after walking age. J Pediatr Orthop. 1982;
2(5):478-86.
13. Zionts LE, MacEwen GD. Treatment of congenital
dislocation of the hip in children between the ages
of one and three years. J Bone Joint Surg Am. 1986;
68(6):829-46.
14. Terjesen T, Horn J. Have changes in treatment of latedetected
developmental dysplasia of the hip during
the last decades led to better radiographic outcome?
Clin Orthop Relat Res. 2016; 474(5):1189-98.
15. Bulut M, Gürger M, Belhan O, Batur OC, Celik S,
Karakurt L. Management of developmental dysplasia
of the hip in less than 24 months old children. Indian J
Orthop. 2013; 47(6):578-84.
16. Kotzias Neto A, Ferraz A, Bayer Foresti F, Barreiros
Hoffmann R. Bilateral developmental dysplasia of the
hip treated with open reduction and Salter osteotomy:
analysis on the radiographic results. Rev Bras Ortop.
2014; 49(4):350-8.
17. Salter RB, Dubos JP. The first fifteen year’s personal
experience with innominate osteotomy in the
treatment of congenital dislocation and subluxation
of the hip. Clin Orthop Relat Res. 1974; 98(1):72-103.
18. Nakamura S, Ninomiya S, Takatori Y, Morimoto
S, Umeyama T. Long-term outcome of rotational
acetabular osteotomy: 145 hips followed for 10-23
years. Acta Orthop Scand. 1998; 69(3):259-65.
19. Erturk C, Altay MA, Yarimpapuc R, Koruk I, Isikan UE.
One-stage treatment of developmental dysplasia of
the hip in untreated children from two to five years
old. A comparative study. Acta Orthop Belg. 2011;
77(4):464-71.
20. Tezeren G, Tukenmez M, Bulut O, Percin S, Cekin T.
The surgical treatment of developmental dislocation
of the hip in older children: a comparative study. Acta
Orthop Belg. 2005; 71(6):678-85.
21. Tukenmez M, Tezeren G. Salter innominate osteotomy
for treatment of developmental dysplasia of the hip. J
Orthop Surg. 2007; 15(3):286-90.
22. Yagmurlu MF, Bayhan IA, Tuhanioglu U, Kilinc AS,
Karakas ES. Clinical and radiological outcomes are
correlated with the age of the child in single-stage
surgical treatment of developmental dysplasia of the
hip. Acta Orthop Belg. 2013; 79(2):159-65.
23. Ganger R, Radler C, Petje G, Manner HM, Kriegs-
Au G, Grill F. Treatment options for developmental
dislocation of the hip after walking age. J Pediatr
Orthop Part B. 2005; 14(3):139-50.
24. Raiman A. Comments on the contribution: F. Grill
and B. Frischhut: “Results of treatment of chronic
congenital hip dislocation after learning to walk. Z
Orthop Ihre Grenzgeb. 1992; 130(3):251.
25. Ruszkowski K, Pucher A. Simultaneous open reduction
and Dega transiliac osteotomy for developmental
dislocation of the hip in children under 24 months of
age. J Pediatr Orthop. 2005; 25(5):695-701.
26. Mazloumi SM, Ebrahimzadeh MH, Kachooei AR.
Evolution in diagnosis and treatment of Legg-Calve-
Perthes disease. Arch Bone Jt Surg. 2014; 2(2):86-92.
27. Vafaee AR, Baghdadi T, Baghdadi A, Jamnani RK. DDH
epidemiology revisited: do we need new strategies?
Arch Bone Jt Surg. 2017; 5(6):440-2.