Salter pelvic osteotomy combined with proximal femoral osteotomy in treatment of children hip dysplasia

doi:10.3877/cma.j.issn.1674-134X.2025.04.001

Abstract

Abstract:

Objective

To summarize the clinical efficacy and experience of Salter pelvic osteotomy combined with proximal femoral osteotomy in the treatment of children with developmental dysplasia of the hip (DDH), and to analyze the effects of the differences in age, acetabular index, and the degree of subluxation on the clinical efficacy.

Methods

Children diagnosed with DDH who underwent Salter pelvic osteotomy combined with proximal femoral osteotomy in the Department of Joint Surgery of the 940th Hospital of PLA Joint Logistics Support Force from January 2010 to December 2020 were enrolled, and the patients with cerebral palsy, joint disorders or spinal cord diseases and incomplete data were excluded. A retrospective study of the clinical data was carried out to analyze acetabular index (AI) and center-edge angle (CE angle) in the orthopantomograms of the pelvis taken at before operation, one day, three and six months, as well as one, two, and three years of follow-up. The treatment effect was evaluated according to the Severin radiological criteria and the Mckay hip functionality score at the final follow-up after the operation, and the surgery-related complications were counted. The patients were then divided into groups according to different ages, degrees of dislocation (IHDI typing), and acetabular indices (AI), and differences in clinical efficacy were comparatively analyzed using the Spearman correlation coefficient test.

Results

A total of 70 children (88 hips) with DDH were enrolled, including 23 males and 47 females, with average age of (36±15) months at the time of Salter osteotomy. At the final follow-up, 79 hips were excellent and nine hips were good according to Severin criteria; while in Mckay score, 51 hips were excellent, 21 hips were good, 13 hips were moderate, and three hips were poor. Postoperative complications occurred in six cases and six hips, including three cases and three hips of femoral stem fracture, one case and one hip of femoral head necrosis, and two cases and two hips of joint stiffness with limitation of movement after internal fixation removal. Severin standard evaluation of children≤three years old group was excellent in 55 hips, Mckay score was excellent in 43 hips, good in 12 hips. Severin standard evaluation of children>three years old was excellent in 24 hips, good in nine hips; Mckay scores were excellent in eight hips, good in nine hips, moderate in 13 hips, poor in three hips. The patient age was negatively corelated to Severin grades and Mckay scores at the last follow-up (R=-0.469, -0.681, both P<0.01). According to the IHDI subgroups, children with IHDI type Ⅲ had 59 excellent hips for Severin’s criteria, while 44 excellent hips and 15 good hips according to Mckay score. Children with IHDI type Ⅳ had 20 excellent hips and nine good hips by Severin’s criteria, while seven excellent hips, six good hips, 13 moderate hips and three poor hips according to Mckay’s score. IHDI stages were negatively correlated to Severin grades and Mckay scores at the last follow-up (R=-0.481, -0.591, both P<0.01). In the children with AI≤35°, Severin’s criteria was excellent in 47 hips, Mckay’s score was excellent in 37 hips, good in 10 hips. Severin’s criteria in the children with AI>35° were evaluated as excellent in 32 hips, good in nine hips, while according to Mckay’s scores 14 hips were excellent, 11 hips were good, 13 hips were moderate and three hips were poor ( R=-0.361, -0.515, both P<0.01).

Conclusions

Salter pelvic osteotomy combined with proximal femoral osteotomy for the treatment of DDH can significantly improve the morphology and function of the hip joint, improve the quality of life of the children, and have fewer related complications. Among them, children≤3Years old, IHDI type Ⅲ, and AI≤35°obtained better hip joint morphology and function.

Key words: Developmental dysplasia of the hip, Orthopedic procedures, Osteotomy, Child, Treatment outcome

Chunnuo He, Zhimin Tian, Haoqiang Zhang, Huanxi Li, Kaipeng Zhuang, Yongjie Qiao, Shenghu Zhou, Ping Zhen. Salter pelvic osteotomy combined with proximal femoral osteotomy in treatment of children hip dysplasia[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(04): 391-401.

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URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-134X.2025.04.001

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2025/V19/I04/391

Figures/Tables 6

Figure 1 Measurement of the acetabular indexNote: angle between the line connecting the lowermost tip of the ilium and the outermost rim of the acetabulum (blue line) and the H line (red line)

Figure 2 Measurement of CEA (central edge angle)Note: the angle between the vertical line across the center of the femoral head (red line) and the line connecting the center of the femoral head and the outer rim of the acetabulum (blue line)

Figure 3 Locating the center of the femoral headNote: draw two parallel tangent lines along the medial and lateral cortex of the femoral neck (orange and green lines); take the mid-pituitary line between the two tangent lines as the anatomical axis of the femoral neck (red line); extend this axis proximally, and its intersection with the proximal epiphyseal plate of the femur (blue line) is defined as the geometric center of the femoral head

Table 1 Comparative analysis of AI and CEA before and after surgery in children[n=88，°，（

±s）]

组别Groups	AI	CEA
术前Before operation	36.0±6.2	-
术后1 d One day after operation	20.1±6.7	32.6±9.2
术后3个月Three months after operation	19.6±6.5	33.9±8.8
术后6个月Six months after operation	17.7±5.5	34.3±8.5
术后1年One year after operation	15.6±4.7	36.1±8.4
术后2年Two years after operation	13.7±3.9	36.3±8.2
术后3年Three years after operation	12.8±3.8	36.5±8.2
t值	53.23^a、62.86^b、64.69^c、65.05^d	-
P值	<0.001^abcd	-

Figure 4 Antero-posterior X ray images of bilateral hips before and after bilateral Salter pelvic osteotomy combined with proximal femoral osteotomy. A is image before operation, showing bilateral hip dysplasia; B is one day after the left hip operation, showing good orthopedics of the left hip and good position of internal fixation; C is image at one day after the right hip operation and three months after the left hip operation, showing that the orthopedics of both hips were satisfactory, and the positions of internal fixations were good without displacement; D is image at the six months after the left hip operation and three months after the right hip operation, showing good internal fixation positions of both sides; E is image at one year the left hip operation and nine months after the right hip operation, showing good internal fixation positions of both sides; F is image at two years after left hip surgery and 21 months after right hip joint surgery, showing that both hips were satisfactorily corrected, the positions of internal fixations were good, and the bone healing was good; G is image at three years after left hip surgery, two years and nine months after right hip surgery, showing that both hips were in satisfactory positions, and internal fixatiors had been taken out

Figure 5 Antero-posterior X ray images of bilateral hips before and after left Salter pelvic osteotomy combined with proximal femoral osteotomy images. A is image before operation, showing left hip dysplasia; B is one day after the left hip operation showing good correction of left hip and good position of internal fixation; C to E were images at three, six, and 12 months after surgery, showing satisfactory position of the left hip joint, and good position of the internal fixation with no displacement; F was image at two years after left hip surgery, showing that the left hip was in satisfactory position and the internal fixation had been taken out; G is image at three years after left hip surgery, showing that left hip healed well without other complications.

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