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Appropriate Surgical Timing of Salter Innominate Osteotomy for Residual Acetabular Dysplasia in Children
Kenta Sawamura1,2, Hiroshi Kitoh1,3, Hiroshi Kaneko1
1Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, Obu.
Insights
Salter innominate osteotomy (SIO) effectively treats acetabular dysplasia. Optimal results for this hip surgery are achieved when performed in children aged 8 years or younger, ensuring better long-term outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Hip Dysplasia Treatment
Background:
- Salter innominate osteotomy (SIO) is a recognized surgical procedure for residual acetabular dysplasia in children.
- Assessing the optimal timing for SIO is crucial for maximizing treatment efficacy.
- Midterm outcomes of SIO based on patient age at surgery require further investigation.
Purpose of the Study:
- To evaluate the midterm results of Salter innominate osteotomy (SIO).
- To determine the optimal age for performing SIO in patients with acetabular dysplasia.
- To correlate surgical timing with long-term hip joint coverage and patient outcomes.
Main Methods:
- Retrospective analysis of 50 hips in 42 patients with acetabular dysplasia who underwent SIO.
- Measurement of the center-edge angle (CEA) preoperatively, postoperatively, and at skeletal maturity.
- Classification of patients into three age groups: <7 years, 7-8 years, and ≥9 years at the time of surgery.
Main Results:
- SIO significantly improved the mean center-edge angle (CEA) from 0.9° preoperatively to 28.1° at skeletal maturity.
- 90% of hips achieved Severin I or II classification, indicating good to excellent outcomes.
- Patients younger than 9 years showed significantly greater improvement in CEA from postoperative to skeletal maturity compared to older patients.
Conclusions:
- Salter innominate osteotomy (SIO) yields favorable outcomes and satisfactory acetabular coverage in young children.
- Older patients (≥9 years) undergoing SIO experienced limited postoperative remodeling and less secondary improvement in CEA.
- Performing SIO in patients aged 8 years or younger is recommended for optimal results in acetabular dysplasia treatment.
Background:
Salter innominate osteotomy (SIO) provides favorable results for treating residual acetabular dysplasia in young children. In this study, we examined the midterm results of SIO according to the age at surgery to determine the optimal timing of this procedure.
Methods:
We retrospectively examined 50 hips of 42 patients (8 boys and 34 girls) with acetabular dysplasia who underwent SIO and were followed up until skeletal maturity. The center-edge angle (CEA) was measured based on the anteroposterior radiographs of the hip obtained before surgery, 5 weeks after surgery, and at the latest follow-up. Severin classification was evaluated at the latest follow-up. Patients were categorized into 3 groups according to age at surgery: younger than 7 years of age (group A), 7 to 8 years of age (group B), and 9 years of age or older (group C).
Results:
The mean preoperative CEA level of 0.9 degrees improved to 17.1 degrees postoperatively, which was increased to 28.1 degrees at the latest examination. Overall, 45 hips (90%) were classified as Severin I or II, with 96% in group A, 94% in group B, and 57% in group C. In group C, postoperative acetabular coverage was similar to that in the other groups (16.6 degrees in group A, 14.8 degrees in group B, and 18.1 degrees in group C), although the final outcome was unsatisfactory. The average improvement in CEA from postoperative to skeletal maturity was significantly smaller in group C than in the other groups (12.7 degrees in group A, 11.3 degrees in group B, and 3.0 degrees in group C).
Conclusions:
SIO showed favorable outcomes with satisfactory acetabular coverage at skeletal maturity. However, satisfactory acetabular coverage could not be obtained in some older patients because of limited postoperative remodeling capacity and smaller secondary improvement of CEA. We recommend that SIO should be performed in patients aged 8 years or younger.
Level Of Evidence:
Level III-retrospective comparative study.
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