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Modified Pemberton osteotomy for developmental dysplasia of the hip in children: a mid- to long-term follow-up study
Ting Lei1,2, Kun Liu1,2, Jin Tang1,2
1Orthopedic Department, Hunan Children's Hospital (The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University), Changsha, Hunan, China.
Insights
The modified Pemberton osteotomy (MPO) offers safe and effective surgical treatment for developmental dysplasia of the hip (DDH) in children. This technique demonstrates durable clinical and radiographic improvements with reduced risk of growth plate injury.
Area of Science:
- Pediatric Orthopedics
- Surgical Innovation
- Hip Dysplasia Treatment
Background:
- Developmental dysplasia of the hip (DDH) is a common pediatric condition.
- Conventional Pemberton osteotomy risks iatrogenic injury to the triradiate cartilage.
- Modified Pemberton osteotomy (MPO) repositions the osteotomy to protect the growth plate.
Purpose of the Study:
- Evaluate the mid- to long-term efficacy and safety of MPO in pediatric DDH.
- Compare MPO outcomes to conventional methods.
- Assess functional and radiographic results after MPO.
Main Methods:
- Retrospective review of 55 patients (71 hips) treated with open reduction and MPO.
- Analysis of radiographic parameters: acetabular index (AI), central-edge angle (CEA), Reimer index (RI).
- Outcomes assessed using McKay criteria (clinical) and Severin classification (radiographic).
Main Results:
- Mean follow-up of 7.21 years showed significant improvement in AI (39.66° to 12.71°).
- 88.7% excellent-good clinical outcomes (McKay criteria) and 93.0% excellent-good radiographic outcomes (Severin classification).
- Avascular necrosis (AVN) incidence was 11.2%, considered acceptable and procedure-related.
Conclusions:
- MPO provides favorable and durable mid- to long-term outcomes for pediatric DDH.
- MPO enhances surgical safety by avoiding triradiate cartilage injury.
- The procedure demonstrates an acceptable AVN rate, highlighting its improved safety profile.
Background And Objective:
Developmental dysplasia of the hip (DDH) is a common pediatric condition requiring timely surgical intervention in older children. Conventional Pemberton osteotomy, while effective, carries a risk of iatrogenic injury to the triradiate cartilage due to its blind deep-pericapsular trajectory. The modified Pemberton osteotomy (MPO) shifts the osteotomy endpoint to 3-5 mm above the sciatic notch, creating a greenstick hinge above the Y-shaped cartilage to avoid growth-plate damage. This study aimed to evaluate the mid- to long-term efficacy and safety of MPO in children with DDH over a minimum follow-up of 5 years.
Materials And Methods:
We retrospectively reviewed 55 patients (71 hips) who underwent open reduction combined with MPO between May 2004 and June 2025. Radiographic parameters included acetabular index (AI), central-edge angle (CEA), and Reimer index (RI). Clinical and radiographic outcomes were assessed using McKay criteria and Severin classification, respectively.
Results:
The mean follow-up duration was 7.21±1.64 years. The mean AI improved from 39.66 ± 5.46° preoperatively to 12.71 ± 8.37° at final follow-up, demonstrating powerful and stable acetabular remodeling capacity. According to the McKay clinical criteria, highly satisfactory functional outcomes were achieved, with an excellent-good rate of 88.7% (63/71 hips). Radiographic assessment using the Severin classification confirmed excellent joint congruence, yielding an excellent-good rate of 93.0% (66/71 hips). Avascular necrosis (AVN) occurred in 8 hips (11.2%), which is a low and acceptable incidence compared to historical pelvic osteotomies.
Conclusion:
MPO provides favorable and durable mid- to long-term clinical and radiographic outcomes for DDH in children. By avoiding iatrogenic injury to the triradiate cartilage, MPO offers improved surgical safety compared with conventional Pemberton osteotomy, with an acceptable AVN rate directly attributable to the procedure.
