The Salter innominate osteotomy: should it be combined with concurrent open reduction?

The timing of surgical realignment of the acetabulum after reduction of the dysplastic hip is controversial since a delay in correction may allow the joint to sublux again. The radiographic outcome after 188 Salter osteotomies was reviewed 5-25 years postoperatively using a comprehensive rating scale; 139 hips (69%) developed satisfactorily, 49 hips (26%) remained dysplastic but stable and nine hips (5%) were unsatisfactory. The best results occurred in children under the age of 30 months treated by combined open reduction and Salter osteotomy, when no further operation was required. The staged procedure yielded a slightly smaller proportion of satisfactory results, which were independent of the age of the child (and the incidence of redisplacement and avascular change was reduced). If the innominate osteotomy reduced the acetabular inclination by approximately 15 degrees the hip joint usually stabilized and a normal acetabular (Sharp) angle was present at maturity. When 132 patients were assessed clinically at maturity (between the ages of 16 and 35 years), clinical, functional and radiographic review revealed that 121 of 148 hips were graded in Severin groups I and II. The clinical outcome was determined by the degree to which the acetabular dysplasia was corrected.