Comparison of Acetabular Anterior Coverage After Salter Osteotomy and Pemberton Acetabuloplasty: A Long-term Followup

Abstract

Background The Salter osteotomy and Pemberton acetabuloplasty are common procedures for a deficient acetabulum in patients with developmental dysplasia of the hip. However, the degree of increasing retroversion and anterior acetabular coverage of these two procedures remains unanswered. Questions/purposes The purpose of this study is to show the change in anterior coverage and relevant parameters in measuring pain and function among patients who have undergone either a Salter osteotomy or Pemberton acetabuloplasty. Methods Forty-two patients who underwent either a Salter or Pemberton procedure at one institution between January 1981 and December 2000 and were available for followup at least 10 years later (mean, 18 years; range, 12-28 years) were evaluated retrospectively. This represented 12% of the Salter and Pemberton procedures performed in patients between 12 and 36 months old at our institution during the study period. We measured verticalcenter-anterior margin angle, anterior acetabular head index, and weightbearing zone acetabular index, and we made comparisons using the radiographic parameter ratio (the division of each radiographic measurement of the operative side by that of the nonoperated side). All patients completed SF-36 and Harris hip score questionnaires at followup. Results In the Salter group, there were no differences in vertical-center-anterior margin angle, anterior acetabular head index, or weightbearing zone acetabular index. In the Pemberton group, there was no difference in vertical-center-anterior margin angle or anterior acetabular head index, but the weightbearing zone acetabular index decreased, suggesting increased anterior acetabular coverage (surgically treated side, 6 [95% CI, 4.84, 7.16]; nonoperated side, 12 [95% CI, 10.07, 13.39]; p \ 0.001). Compared with that in the Salter group, the weightbearing zone acetabular index ratio was smaller in the Pemberton group, which means more acquired anterior coverage after a Pemberton acetabuloplasty (Salter procedure, 0.94 [95% CI, 0.70, 1.17], Pemberton procedure, 0.53 [95% CI, 0.40, 0.65]; p \ 0.001). Three patients in the Pemberton group had an anterior impingement sign at followup, whereas none in the Salter group did. The SF-36 and Harris hip scores were good and showed no differences between the two groups.

Does Salter Innominate Osteotomy Predispose the Patient to Acetabular Retroversion in Adulthood?

“…This observation contradicts Reynolds et al's proposal [16] that all the symptomatic hips with acetabular retroversion have a positive anterior impingement. The comparison study between Salter and Pemberton osteotomy by Wang et al [24] showed no patient displayed a positive anterior impingement sign in the patients after Salter osteotomy compared with 11% of patients showing a positive sign after Pemberton osteotomy. Their study showed less frequency of clinical sign of FAI after Salter osteotomy and was consistent with ours.…”

Pedobarographic Analysis Following Pemberton's Pericapsular Osteotomy for Unilateral Developmental Dysplasia of the Hip

“…Pemberton pericapsular osteotomy (PPO) was defined by Pemberton 6 in 1965 and is widely recognized as a safe and effective procedure both in terms of clinical and radiographic outcomes in children. 7 – 11 However, there are reports of residual gait deviations in patients previously treated with PPO for DDH that decreased function and made revision surgery challenging. 12 , 13 …”

Pelvic Osteotomies for Developmental Dysplasia of the Hip

“…In one study comparing long-term results of those two osteotomies, it suggested that by modifying the acetabular shape, the Pemberton osteotomy may result in an increase in anterior acetabular coverage. This in term may increase the risk of impingement [10]. Leg length discrepancy with longer leg at pathology side may be caused by coxa valga due to Kalamchi type II osteonecrosis of femoral head or trans-iliac lengthening of the pelvis [6].…”