Open reduction combined with Salter or Pemberton osteotomy and proximal femoral osteotomy for the management of developmental dislocation of the hip in children between the ages of 2 and 3 years

Abstract

Objective The objective was to discussing the difference between the Pemberton osteotomy and Salter osteotomy which performed in patients between the ages of 2 and 3 years who suffered from developmental dislocation of the hip (DDH). Methods A retrospective review of the results of operation treatment for DDH in 59 children (84 hips) from January 1998 to December 2008 was conducted. There are 10 boys (14 hips) and 49 girls (70 hips). The age of the patients was between 2-3 years old at the time of treatment 2.5±0.4 years. Surgery consist of open reduction of the hip, capsulorraphy, shortening and derotational osteotomy of proximal femur, and innominate osteotomy which include Pemberton osteotomy (33 hips), Salter osteotomy (51 hips). McKay and Severin modified criteria were used to assess the function and radiographic results of the hip. Results The average follow-up time was 5.6±3.5 years ranging from 2 to 16 years. According to Severin criteria at final follow-up, 78 hips (93%) had excellent and good results; 4 hips were fair and 2 hips poor result. The radiology results in Salter osteotomy were better than Pemberton osteotomy (rate of excellent and good results 100% vs. 82%, χ2=7.43,P=0.003). According to the McKay criteria Salter osteotomy and Pemberton osteotomy have no significant difference in latest follow-up (the satisfactory rate 100% vs. 97%, χ2=1.56,P= 0.39). 18 hips (21%) had proximal femoral growth disturbance which 10 hips in Pemberton group, 8 hips in Salter group. There is no significant difference (χ2=2.54,P=0.17). Conclusion Open reduction, innominate osteotomy and proximal femoral osteotomy were effective procedures for the treatment of DDH in children between 2-3 years old. More attention should be taken in Pemberton osteotomy to prevent the acetabular bony edge absorption. Key words: Hip dislocation, congenital; Osteotomy; Femur head necrosis