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[IMPACT OF SALTER INNOMINATE OSTEOTOMY ON ACETABULAR MORPHOLOGY AND DIRECTION IN DEVELOPMENTAL DISLOCATION OF THE HIP
Insights
Salter innominate osteotomy improves acetabular morphology in developmental dislocation of the hip (DDH) by increasing anterior curvature and decreasing posterior curvature. This procedure significantly reduces acetabular anteversion, with outward and forward rotation being key factors.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Radiology
Background:
- Developmental dislocation of the hip (DDH) requires surgical correction to improve acetabular morphology and hip joint stability.
- Salter innominate osteotomy is a common surgical technique used to address acetabular dysplasia in DDH.
- Understanding the precise impact of this osteotomy on acetabular parameters is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To evaluate the effects of Salter innominate osteotomy on acetabular morphology and direction in children with DDH.
- To investigate the relationship between surgical rotational changes and alterations in acetabular parameters.
- To utilize three-dimensional CT scans for precise quantitative analysis before and after surgical intervention.
Main Methods:
- A cohort of 51 female patients with unilateral DDH, aged 1 year 6 months to 5 years, underwent open reduction, Salter innominate osteotomy, and proximal femoral osteotomy.
- Three-dimensional CT scans were performed pre-operatively and 1 week post-operatively to measure anterior acetabular index (AAI), posterior acetabular index (PAI), axial acetabular index (AxAI), and acetabular anteversion angle (AAA).
- Spearman correlation analysis was employed to assess the relationship between the rotational distances of osteotomy fragments and changes in acetabular indices and angles.
Main Results:
- Significant improvements were observed in AAI, PAI, and AAA post-surgery (P < 0.05), while AxAI showed no significant change.
- The mean differences were: AAI (4.518 ± 4.601)°, PAI (4.219 ± 6.660)°, and AAA (3.919 ± 4.389)°.
- Outward rotation of osteotomy fragments strongly correlated with AAI difference (r=0.981), and forward rotation correlated with AAA difference (r=0.841).
Conclusions:
- Salter innominate osteotomy effectively enhances anterior acetabular wall curvature and reduces posterior wall curvature in DDH.
- The procedure significantly decreases acetabular anteversion, indicating a change in acetabular direction, but does not alter acetabular depth.
- Outward rotation is the primary driver of acetabular curvature changes, while forward rotation is the main factor influencing acetabular direction.
Objective:
To investigate the impact of the Salter innominate osteotomy on the acetabular morphology and direction and the relationship between them in children with developmental dislocation of the hip (DDH) by three-dimensional CT.
Methods:
Between January 2013 and January 2015, 51 patients with unilateral DDH were treated. All patients were females with an average age of 2 years and 5 months (range, one year and 6 months to 5 years). All the patients underwent open reduction of the hip, Salter innominate osteotomy, proximal femoral osteotomy, and hip cast immobilization for treatment. The data of three-dimensional CT before surgery and at 1 week after surgery were measured and collected as follows: the anterior acetabular index (AAI), posterior acetabular index (PAI), axial acetabular index (AxAI), acetabular anteversion angle (AAA) of the acetabulum, and the distances of the forward, outward, and lateral rotation of the distal osteotomy fragments. The differences of AAI, PAI, AxAI, AAA between before and after surgeries were compared and the difference values of the data with significant difference results were calculated. The relationship between the difference values and the distances of three different rotation directions before and after surgeries were tested by Spearman correlation analysis.
Results:
There were significant differences in the AAI, PAI, and AAA between before and after surgery (P < 0.05), but no significant difference was found in the AxAI between before and after surgery (t = 0.878, P = 0.384). The difference values of AAI, PAI, and AAA were (4.518 ± 4.601), (4.219 ± 6.660), and (3.919 ± 4.389)° respectively. The distances of the outward, lateral, and forward rotation of the distal osteotomy fragments after surgery were (0.420 ± 0.339), (2.440 ± 0.230), and (0.421 ± 0.311) cm. There was a significant correlation between the three different rotation directions and AAI difference (P < 0.05), especialy the outward rotation (r=0.981). There was a correlation between the outward, forward rotation and PAI, AAI differences (P < 0.05), and no significant correlation between the lateral rotation and PAI, AAA was found (P > 0.05). There was a significant correlation between the forward rotation and AAA difference (r = 0.841).
Conclusion:
Salter innominate osteotomy can increase the curvature of the anterior wall of the acetabulum in DDH, but reduce the curvature of the rear wall. At the same time, it can also change the direction of the acetabulum, significantly decrease the acetabular anteversion, but it can not change the depth of the acetabulum. The main factors of the curvature change after Salter innominate osteotomy of DDH is attributable to outward rotation, followed by forward rotation, and the main factor of the acetabular direction change is attributable to forward rotation.
