Advantages of Single-Stage Surgical Treatment with Salter Innominate Osteotomy and Pemberton Pericapsular Osteotomy for Developmental Dysplasia of Both Hips

Abstract

OBJECTIVE: This study retrospectively compared the clinical and radiological outcomes of patients with bilateral developmental dysplasia of the hip who underwent either a single-stage operation (using a Salter innominate osteotomy for one hip and a Pemberton pericapsular osteotomy for the other hip) or a two-stage procedure comprising consecutive operations. METHODS: Extensive pre- and postoperative clinical, surgical and radiological examinations were undertaken. RESULTS: A total of 63 patients received the single-stage operation (group A), and 55 patients received consecutive operations (group B). There were no significant between-group differences in acetabular index or centre-edge angle correction. Group A had significantly reduced anaesthetic exposure, duration of hospitalization, blood transfusion volume, antibiotic costs and hospitalization costs. Group A also had a lower rate of surgical complications and avascular necrosis than group B. CONCLUSIONS: The single-stage surgical procedure was more economical and allowed more rapid recovery than two consecutive operations. The surgical and anaesthesia team must be highly proficient in order to perform single-stage operations successfully.

Keywords

Developmental Dysplasia of the Hip Single-Stage Osteotomy Consecutive Osteotomies Salter Innominate Osteotomy PEmberton Pericapsular Osteotomy

References

Tachdjian

: Congenital deformities. In: Pediatric Orthopedics, 2nd edn ( Tachdjian

ed). Philadelphia: WB Saunders, 1990; pp 297–549.

Tachdjian

: Treatment after walking age. In: Congenital Dislocation of the Hip ( Tachdjian

, ed). New York: C Livingstone, 1982; pp 339–365.

Ege

: Overview to pelvic osteotomies. In: Hip Surgery and Problems ( Ege

ed). Ankara: THK Press, 1994; pp 313–329 [in Turkish].

Zorer

Bagatur

: Single-stage bilateral Pemberton's pericapsular osteotomy in bilateral developmental dysplasia of the hip. Acta Orthop Traumatol Turc 2002; 36: 288–294 [in Turkish, English abstract].

Rab

: Containment of the hip: A theoretical comparison of osteotomies. Clin Orthop Relat Res 1981; 154: 191–196.

McKay

: A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clin Orthop Relat Res 1974; 98: 124–132.

Mergen

Isiklar

Omeroglu

: Open reduction for the treatment of congenital dislocation of hip: combination of Salter and femoral osteotomies. Ankara Med J 1991; 44: 563–574 [in Turkish].

Zorer

Sürel

Savran

: Comparison of effectiveness of Salter and Pemberton operations in treatment of DDH. In: XIIIth National Turkish Orthopaedics and Traumatology Congress Book. Ankara: TNK Press, 1994; 374–377 [in Turkish].

Ochoa

Seringe

Soudrie

: Salter's single-stage bilateral pelvic osteotomy. Rev Chir Orthop Reparatrice Appar Mot 1991; 77: 412–418 [in French, English abstract].

10.

Zamzam

Khosshal

Abak

: One-stage bilateral open reduction through a medial approach in developmental dysplasia of the hip. J Bone Joint Surg Br 2009; 91: 113–118.

11.

Tönnis

: Congenital Dysplasia and Dislocation of the Hip in Children and Adults. Berlin: Springer, 1987; p 83.

12.

Kalamchi

MacEwen

: Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980; 62: 876–888.

13.

Sutherland

Greenfield

: Double innominate osteotomy. J Bone Joint Surg Am 1977; 59: 1082–1091.

14.

Berkeley

Dickson

Cain

: Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old. J Bone Joint Surg Am 1984; 66: 412–420.

15.

Trevor

Johns

Fixsen

: Acetabuloplasty in the treatment of congenital dislocation of the hip. J Bone Joint Surg Br 1975; 57: 167–174.

16.

Severin

: Contribution to the knowledge of congenital dislocation of the hip joint: late results of closed reduction and arthrographic studies of recent cases. JAMA 1942; 118: 565–566.

17.

Salter

: Innominate osteotomy in the treatment of congenital hip dislocation and subluxation of the hip. J Bone Joint Surg Br 1961; 43: 518–539.

18.

Pemberton

: Pericapsular osteotomy of the ilium for the treatment of congenitally dislocated hips. Clin Orthop Relat Res 1974; 98: 41–54.

19.

Kessler

Stevens

Smith

: Use of allografts in Pemberton osteotomies. J Pediatr Orthop 2001; 21: 468–473.

20.

Bagatur

Zorer

Sürel

: Is sufficient femoral head coverage obtained after Pemberton's pericapsular osteotomy? Evaluated by three-dimensional computed tomographic reconstruction. Acta Orthop Traumatol Turc 2002; 36: 203–210 [in Turkish, English abstract].

21.

Salter

Hansson

Thompson

: Innominate osteotomy in the management of residual congenital subluxation of the hip in young adults. Clin Orthop Relat Res 1984; 182: 53–68.

22.

Wedge

Salter

: Innominate osteotomy: its role in arrest of secondary degenerative arthritis of the hip in the adult. Clin Orthop Relat Res 1974; 98: 214–224.

23.

Chiari

: Medial displacement osteotomy of the pelvis. Clin Orthop Relat Res 1974; 98: 55–71.

24.

Albiñana

Morcuende

Weinstein

: The teardrop in congenital dislocation of the hip diagnosed late. A quantitative study. J Bone Joint Surg Am 1996; 78: 1048–1055.

25.

Tokgözoğlu

: Pemberton osteotomy. In: Hip Surgery and Problems ( Ege

ed). Ankara: THK Press, 1996; pp 337–344 [in Turkish].

26.

Ganz

Klaue

Vinh

: A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res 1988; 232: 26–36.

27.

Pemberton

: Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dislocation of the hip. J Bone Joint Surg Am 1965; 47: 65–86.