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

Abstract

Background Salter innominate osteotomy has been identified as an effective additional surgery for the dysplastic hip. However, because in this procedure, the distal segment of the pelvis is displaced laterally and anteriorly, it may predispose the patient to acetabular retroversion. The degree to which this may be the case, however, remains incompletely characterized. Questions/purposes We asked, in a group of pediatric patients with acetabular dysplasia who underwent Salter osteotomy, whether the operated hip developed (1) acetabular retroversion compared with contralateral unaffected hips; (2) radiographic evidence of osteoarthritis; or (3) worse functional scores. (4) In addition, we asked whether femoral head deformity resulting from aseptic necrosis was a risk factor for acetabular retroversion. Methods Between 1971 and 2001, we performed 213 Salter innominate osteotomies for unilateral pediatric dysplasia, of which 99 hips (47%) in 99 patients were available for review at a mean of 16 years after surgery (range, 12-25 years). Average patient age at surgery was 4 years (range, 2-9 years) and the average age at the most recent followup was 21 years (range, 18-29 years). Acetabular retroversion was diagnosed based on the presence of a positive crossover sign and prominence of the ischial spine sign at the final visit. The center-edge angle, acetabular angle of Sharp, and acetabular index were measured at preoperative and final visits. Contralateral unaffected hips were used as controls, and statistical comparison was made in each patient. Clinical findings, including Harris hip score (HHS) and the anterior impingement sign, were recorded at the final visit. 123Clin Orthop Relat Res (2015) 473:1755-1762 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® ischial spine signs. There was no significant difference in HHS between the crossover-positive and crossover-negative patient groups nor in the prominence of the ischial spine-positive and prominence of the ischial spine-negative patient groups (crossover sign, p = 0.68; prominence of the ischial spine sign, p = 0.54). Hips with femoral head deformity (25 of 99 hips [25%]) were more likely to have acetabular retroversion compared with hips without femoral-head deformity (crossover sign, p = 0.029, prominence of the ischial spine sign, p = 0.013). Conclusions Our results suggest that Salter innominate osteotomy does not consistently cause acetabular retroversion in adulthood. We propose that retroversion of the acetabulum is a result of intrinsic development of the pelvis in each patient. A longer-term followup study is needed to determine whether retroverted acetabulum after Slater innominate osteotomy is a true risk factor for early osteoarthritis. Femoral head deformity is a risk factor for subsequent acetabular retroversion. Level of Evidence Level III, therapeutic study.

Outcomes and complications of patients undergoing Salter’s innominate osteotomies for hip dysplasia: a systematic review of comparative studies

“…This includes concentric reduction of the femoral head in the acetabulum, good range of motion, having reasonable congruent relationship between the femoral head and the acetabulum and being within the age group of 1.5–6 years old [ 41 ]. An AI greater than 30° or a CEA less than 5° are additional indications for SIO [ 42 ]. Typically, SIO are best reserved for younger patients with more moderate dysplasia as the SIO requires an open triradiate cartilage and provides less correction than other osteotomies such as the Dega osteotomy [ 22 ].…”

MRI-based assessment of acetabular version and coverage after previous Pemberton osteotomy in skeletally mature patients

“…Since preoperative 3D imaging was lacking in our cohort of patients we compared the operated hips with the contralateral sides, a study design that has also been used by other authors. 15 , 17 …”

How Often Does Femoroacetabular Impingement Occur After an Innominate Osteotomy for Acetabular Dysplasia?

“…It has been proven that static factors resulting in abnormal stress and load between the femoral head and the acetabulum lead to asymmetric wear of the chondral surfaces of both the acetabulum and the femoral head, and this can be accentuated when dynamic stress results in abnormal contact between the femoral head and acetabular rim. The presence of acetabular retroversion after an innominate osteotomy is a well-known phenomenon; Salter's innominate osteotomy predisposes to retroversion because it hinges on the symphysis pubis [18]. It has been postulated, however, that this acetabular version will remodel by skeletal maturity.…”