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

Pediatr Traum Orthop Reconstr Surg

Baskaeva²,

Vissarionov³

et al. 2023

BACKGROUND: The choice of pelvic osteotomy in young children with late diagnosis of hip dysplasia most often depends on the experience and preferences of the surgeon, and the diagnosis of the degree of violation of the ratios is based on the generally accepted classification of hip dysplasia without considering possible variants of the deformation of the acetabulum. We hypothesized that the choice of the pelvic osteotomy technique in the surgical treatment of children with hip dysplasia of varying severity should be based on the variant of acetabulum deformation and the corrective capabilities of pelvic osteotomy. AIM: This study aimed to compare and analyze the results of the surgical treatment of children with hip dysplasia of varying severity and to evaluate the effectiveness of the proposed differentiated approach to the choice of the pelvic osteotomy technique. MATERIALS AND METHODS: The study included 150 patients (150 hip joints) aged 24 years (3.1 0.45) with grade IIIV hip dysplasia, according to the supplemented classification of Tnnis. Depending on the verified variant of acetabulum deformity and taking into account the corrective capabilities of various osteotomies, we divided the patients into three groups. All patients underwent conventional clinical and X-ray examinations. During radiometry, the following indicators were evaluated: acetabular index (AI), Wiberg angle, neckshaft angle (NSA), anteversion angle of the proximal femur, degree of bone coverage, acetabulum depth (AD) and pelvic height, length of the acetabular arch (LAA), and presence or absence of a bone oriel (BO). RESULTS: In the comparative analysis of the radiographic anatomical condition of the hip joint in children with hip dysplasia of varying severity, the differentiated use of the modified Salter pelvic osteotomy without autograft and pericapsular acetabuloplasty according to Pemberton and Pembersal surgery led to adequate correction of various variants of congenital acetabular deformity with approximately normal anatomy of the acetabulum and not lead to significant deformation of the hemipelvis, such as elongation. CONCLUSIONS: The results of the surgical treatment of young children with hip dysplasia of varying severity according to the proposed differentiated approach to the choice of the pelvic osteotomy technique, which is based on the variant of acetabulum deformation, indicate the achievement of adequate correction of congenital deformity of the acetabular component of the joint with the restoration of its anatomical structure and avoidance of secondary deformation of the hemipelvis. The effectiveness of the proposed approach to the choice of pelvic osteotomy technique in the treatment of young children with hip dysplasia of varying severity is confirmed by the changes in AI, Wiberg angle, AD, and PH, whose values became close to the individual norm (p 0.05), and reduction of possible secondary deformities.

Section: Discussionunclassified

The choice of pelvic osteotomy technique in young children with hip dysplasia

Pediatr Traum Orthop Reconstr Surg

Baskaeva²,

Vissarionov³

et al. 2023

“…K. Gharanizadeh c коллегами проанализировали изменения АИ у пациентов, которым выполняли операцию Salter в модификации Kalamchi и ацетабулопластику по Pemberton, и не выявили значимых различий в обеих группах. Они пришли к выводу об идентичной эффективности этих двух хирургических способов коррекции диспластичной вертлужной впадины [29]. В нашем исследовании мы получили другой результат -средняя величина коррекции АИ у пациентов после модифицированной остеотомии таза по Salter составила 29,0° против 26,9° у пациентов с перикапсулярной ацетабулопластикой по Pemberton, а послеоперационные значения угла Wiberg составили 39° и 31° соответственно.…”

Section: критерии невключенияunclassified

Salter vs Pemberton: Comparative Radiologic Analysis of Changes in the Acetabulum and Pelvis After Surgical Correction in Children with Hip Dysplasia

Traumatology and Orthopedics of Russia

Baskaeva²,

Vissarionov³

et al. 2022

Background. Hip dysplasia, characterized by pronounced anatomical changes, continues to be one of the leading positions in the structure of all congenital malformations of the musculoskeletal system. Late diagnosis or ineffective conservative treatment leads to the need for surgical correction of congenital deformities of the proximal femur and acetabulum. The choice of the method of operational reconstruction of the latter remains a subject of discussion over the past decades. Aim of the study a comparative X-ray analysis of surgical treatment outcomes of children with hip dysplasia type IHDI IIIIV after Salter and Pemberton pelvic osteotomies. Methods. The study included 80 patients (80 hip joints) aged 2 to 4 years (3.10.45) with hip dysplasia of the IIIIV degree according to the IHDI. Patients were divided into two groups: group I consisted of 40 patients who underwent modified Salter osteotomy, group II 40 patients who underwent Pemberton pericapsular acetabuloplasty. Radiometry of the following parameters was performed: acetabular index (AI), Wiberg angle, neck-shaft angle, anteversion angle of the proximal femur, degree of bone coverage, the depth of the acetabulum (AD) and pelvic height (PH) Results. The values of AI and Wiberg angle in patients in I group indicate that a greater correction was achieved (p0.05) in contrast to patients who underwent Pemberton pericapsular acetabuloplasty. At the same time, the values of AD and PH in I group patients had pronounced differences (p0.05) from those in II group patients, whose values were close to similar indicators in the contralateral hip joint. Conslusions. In the treatment of children with hip dysplasia IHDI III-IV degree performing a modified Salter osteotomy leads to a significant decrease in the values of AI and an increase in the values of the Wiberg angle, which corresponds to hypercorrection of the position of the acetabulum, does not affect the AD and contributes to the elongation of the hemipelvis by an average of 13.8 mm. Pemberton acetabuloplasty allows to achieve values of AI and Wiberg angle close to the age-related indicators of the norm, leads to an increase AD, approaching the contralateral joint in its value and does not significantly affect the PH.

“…рОССИИ / TrAUmAToLogy AND orThopEDICS of rUSSIA ствуют о высокой эффективности применяющихся в мировой ортопедической практике методик хирургической коррекции диспластичной вертлужной впадины как в среднесрочном, так и в отдаленном периодах наблюдения[24,25,26,27]. Отечественными учеными были разработаны рабочие классификации дисплазии тазобедренного сустава.…”

unclassified

Variants of Acetabular Deformity in Developmental Dysplasia of the Hip in Young Children

Traumatology and Orthopedics of Russia

Baskaeva

Vissarionov

et al. 2023

Introdution The choice of a pelvic reconstruction technique in children with DDH has been the subject of discussion for many years and is often determined directly by the surgeon to a greater extent from his personal preferences than from the X-ray anatomical state of the acetabulum, the structural variants of which we have not found in the available scientific literature. Purpose: Based on the X-ray anatomical analysis of the structure of the acetabulum to identify the most common variants of its deformation in children aged 2 to 4 years with varying degrees of severity of hip dysplasia. Materials and methods. The study is based on the results of examination of 200 patients (200 hip joints) aged 2 to 4 years (3.10.45) with II-IV degree of DDH according to D. Tnnis classification. All patients underwent conventional clinical and radiological examination. The latter consisted in performing radiography of the hip joints in several projections and computed tomography. As criteria for determining the most typical variants of acetabulum deformation, we selected the values of the acetabular index, the extent of the acetabulum arch and the presence or absence of a bone oriel. Results. Based on the X-ray analysis of the anatomical structure of the acetabulum in children with DDH, as well as correlation and regression analysis, the 3 most common variants of acetabulum deformity in hip dysplasia in young children were identified, which supplemented the existing DDH classification by D. Tnnis. Conclusion. The analysis of the Xray anatomical condition of the acetabulum in young children with varying severity of DDH showed the presence of three most common variants of acetabulum deformation, which are characterized by: 1 - moderate underdevelopment of the acetabulum arch (AI 35), its shortening and the presence of a bone oriel; 2 - pronounced underdevelopment of the acetabulum arch (AI 35 ), its shortening and the presence of a bone oriel; 3 - pronounced underdevelopment of the acetabulum arch (AI 35 ), its sufficient length and the absence of a bone oriel.