Salter osteotomy without open reduction in the Tönnis type II developmental hip dysplasia: A retrospective clinical study

Abstract

Purpose: We aimed to evaluate the clinical and radiological outcomes of children older than 18 months who were treated with Salter osteotomy without open reduction for Tönnis type II hip dysplasia. Methods: Thirty-two type II hips of 24 patients were included in the study. The mean age was 43.22 (18–108) months. The mean follow-up period was 50 (24–142) months. Seven patients had left sided, nine had right sided, and eight had bilateral developmental dysplasia of the hip. All patients underwent closed reduction and Salter osteotomy. Preoperative and postoperative radiographs were assessed by measuring the center-edge (CE) angle of Wiberg, Smith’s c/b and h/b ratio, and acetabular index (AI). Patients were evaluated clinically according to McKay’s criteria and radiologically according to Severin criteria. The Kalamchi and MacEwen criteria were used in the evaluation of avascular necrosis. Results: The mean preoperative AI, CE angle, c/b, and h/b ratio were 36.7° (±4.1), 7.2° (±5.9), 0.9 (±0.08), and 0.05 (±0.04), respectively. The mean latest follow-up AI, CE angle, c/b, and h/b ratio were 18.2° (±1.7), 38.8° (±5.4), 0.6 (±0.03), and 0.19 (±0.04), respectively. The comparison of preoperative and postoperative radiological values revealed statistically significant improvement (p < 0.01). On the latest physical examinations of the patients, 25 (78.1%) hips were rated excellent, and 7 (21.9%) were rated good according to the McKay criteria. The Severin classification determined 25 (78.1%) hips were grade I and 7 (21.9%) hips were grade II. Type I avascular necrosis (AVN) was seen in four (12.5%) hips. Three of these four hips were more superolateral in preoperative radiographs (c/b > 1 and h/b < 0.05). Conclusions: Salter osteotomy without open reduction is a good surgery option for Tönnis type II hip dysplasia, in which closed reduction can be performed. However, the risk of AVN should be kept in mind in more superolateral type 2 hips.

Modified Salter Pelvic Osteotomy for the DDH Treatment

“…Non-surgical management of DDH is effective in case of early diagnosis, 2 but in neglected cases or after non-surgical treatment failure, surgery is mandatory 3. Pelvic osteotomies are proved to be the most effective surgical option for DDH treatment.…”

“…To evaluate the results after modified SPO, we've selected 19 patients who underwent this surgery for the period 2015-2020. Among these patients 18 were girls (94.7%) and 1 was a boy (5.3%); the left hip joint was affected in 12 cases (63.2%), the right -in 7 cases (36.8%); the mean patient's age was 3.6 ± 1.5 years (2)(3)(4)(5)(6); the mean follow-up period was 2.7 ± 1.6 years (1)(2)(3)(4)(5). During the pelvic osteotomy, we've improved the FH coverage in that direction where it was a deficiency according to X-rays.…”

“… 1 The age of DDH detection is critical - non-surgical treatment is effective only in case of early diagnosis (in non-walking patients). 2 In case of DDH late detection (in walking patients) or after the failure of non-surgical treatment (in case of residual acetabular dysplasia or femoral head redislocation), surgical treatment is indicated. 3 There are different types of surgeries for DDH management, but the best results were observed after pelvic osteotomies application.…”

Salter pelvic osteotomy for the treatment of Developmental Dysplasia of the Hip: assessment of postoperative results and risk factors.

“…1 However, even after the succesful femoral head concentric reduction, residual acetabular dysplasia will occur in 26% of patients. 3 Moreover, in older patients (who started to walk), concentric reduction of the femoral head is difficult to achieve with non-surgical methods due to the adaptive contracture of the surrounding muscles and hypertrophy of intra-articular structures; 66% of these patients will further require surgery. 4 Thus, surgical treatment is mandatory for residual acetabular dysplasia after failed non-surgical treatment and for late-detected DDH.…”

“…4 Thus, surgical treatment is mandatory for residual acetabular dysplasia after failed non-surgical treatment and for late-detected DDH. [1][2][3][4] There are different surgical options for DDH treatment: isolated femoral head open reduction, femoral varus derotational osteotomy (FVDO), different pelvic osteotomies, and the combination of all aforementioned procedures (single-stage surgery -SSS). 2,4 However, better results were detected after pelvic osteotomies or SSS.…”