The Salter innominate osteotomy does not lead to acetabular retroversion
Grace Airey1, James Shelton2, Sara Dorman2
1University of Liverpool.
Insights
Salter
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Radiology
Background:
- Developmental dysplasia of the hip (DDH) is a condition requiring surgical intervention in some cases.
- Salter's innominate osteotomy is a surgical procedure used to correct DDH by improving acetabular coverage.
- Concerns exist that this osteotomy may cause acetabular retroversion, potentially leading to complications.
Purpose of the Study:
- To investigate whether Salter's innominate osteotomy causes acetabular retroversion postoperatively or at long-term follow-up in pediatric patients with DDH.
- To evaluate the long-term effects of the osteotomy on acetabular version.
Main Methods:
- Retrospective review of 92 pediatric patients who underwent unilateral Salter innominate osteotomy for DDH.
- Utilized a novel CT-based technique to measure acetabular version, comparing operated hips with contralateral control hips.
- Assessed acetabular version on postoperative CT scans and follow-up radiographic imaging.
Main Results:
- No incidence of acetabular retroversion was observed in the operated hips immediately postoperatively or at follow-up.
- A statistically significant increase in acetabular anteversion was found in hips that underwent osteotomy compared to control hips (P < 0.001).
- The novel CT measurement technique for acetabular version was found to be repeatable and adjusted for pelvic tilt.
Conclusions:
- Salter's innominate osteotomy does not induce acetabular retroversion in children with DDH.
- The procedure appears to increase acetabular anteversion, contrary to previous concerns.
- This study validates a new CT-based method for accurate acetabular version measurement in DDH patients.
Abstract:
In children with developmental dysplasia of the hip (DDH), Salter's innominate osteotomy aims to surgically manipulate the acetabulum to increase anterior coverage and aid joint support. Consequently, this procedure may retrovert the acetabulum, predisposing patients to pain, osteoarthritis, impingement, or further surgical intervention. In this study, we aim to address whether the innominate osteotomy leads to acetabular retroversion postoperatively or at follow-up. Ninety-two patients were identified from our institutions DDH database between 2009 and 2016, who underwent a unilateral innominate osteotomy for DDH, performed by expert surgeons in a leading paediatric hospital. A novel technique was utilized to measure acetabular version on postoperative computed tomography (CT) scans, where acetabular version was compared between the pathological and contralateral control hips. Measurement of acetabular version in postoperative and control hips demonstrated no incidence of acetabular retroversion. A significant difference was observed when comparing the acetabular version of control versus post-operative hips (P < 0.001), where hips postinnominate osteotomy had a larger degree of acetabular anteversion compared to the control hip. Furthermore, on follow-up radiographic imaging, there was no evidence of acetabular retroversion when using previously defined markers. This study confirms that the Salter innominate osteotomy does not lead to acetabular retroversion both immediately post-operatively and throughout follow-up. In fact, it demonstrates that the acetabula are more anteverted than the contralateral control hip, which has not been previously documented. Additionally, this study demonstrates a novel method of measuring acetabular retroversion using CT technology that adjusts for pelvic tilt, which is repeatable among individuals.
