Long-term results of Salter and Chiari hip osteotomies in developmental hip dysplasia

Abstract

When conservative treatment of developmental hip dysplasia (DDH) does not render satisfactory results, surgical methods are indicated to gain a maximum of joint posture and stability. To assess the efficiency of these surgical procedures, the long-term results of the most often used pelvic osteotomies were examined. As common evaluation scores do not apply for DDH, we developed a specific score system of 100 points to integrate subjective factors such as patient's complaints with objective functional and radiological findings after surgical intervention. Our survey with an average postoperative follow-up examination of 10 years indicated that Salter's innominate osteotomy can render long-term pain relief and enable normal hip development, whereas Chiari's capsular arthroplasty does not. Here, subjective patient complaints do not correlate with clinical and radiological findings, which leads to unsatisfactory results. Ideally, patients aged 2-3 years can undergo Salter's innominate osteotomy whereas the Chiari osteotomy should be considered for patients older than 15 years. Even under optimal surgical conditions, Chiari's osteotomy cannot significantly prevent the development of joint arthritis. Undoubtedly, late results of both surgical procedures are dependent upon the initial stage of DDH. Additional upper femoral correction osteotomies have no further influence on hip development.

A systematic review of the effectiveness and cost-effectiveness of metal-on-metal hip resurfacing arthroplasty for treatment of hip disease

“…The description of prosthesis and fixation was less well ratedseven of the 18 published observational studies and the one published RCT did not adequately describe the procedure. 33,41,[48][49][50]53,55 One concern, relating to the description of the study sample, was that only five (26%) of the 19 published studies adequately described how the sample was selected, [6][7][8]24,45,46,48 and only six of the 19 (32%) published studies specified the inclusion and exclusion criteria. [6][7][8]43,45,46,48,52 None of the unpublished studies adequately described the method of selection of the study sample or specified the inclusion and exclusion criteria.…”

“…45,46,48,52 Both the control of bias in study design and the completeness of follow-up were generally poor in all the osteotomy studies because of their uncontrolled nature. In five studies the type of statistical test used was not specified, 45,47,49,50,54 and in two the conclusions were not justified by the evidence presented. 44,50 …”

“…This outcome was not reported in three studies. 48,49,51 The outcomes of conversions, time in hospital, and quality of life were not reported in any of the studies.…”

“…Of these, one was an RCT, 18 were single-intervention observational studies and three were systematic reviews which included THR studies. 1,30,38 Unpublished data from three industry submissions, [20][21][22] 43 12 on osteotomy [44][45][46][47][48][49][50][51][52][53][54][55] and one on arthrodesis. 33 No published studies relating to arthroscopy were included.…”

Effect of Prior Salter or Chiari Osteotomy on THA with Developmental Hip Dysplasia

“…Even so, this is the largest series to date reported in the literature regarding THA after Salter and Chiari osteotomy. Second, because Chiari osteotomy can change the biomechanical features of the hip and alter the success of later THA [18], followup times of more than 10 years may be required to fully determine its clinical success [16,19,28]. Moreover, the retrospective nature of the study for the period of 1987 to 2002 limited our average followup to 8 years, although this is the longest to date in the literature.…”