Assessment of Pre and Intraoperative Indications of Salter Innominate Osteotomy in Developmental Dysplasia of hip (DDH) in Children Aged (18-36) Months

Abstract

Background: The management of developmental dysplasia of the hip aims for early diagnosis and treatment. It is claimed that adequate acetabular remodelling is possible only during the first18 months of life. After this, satisfactory development cannot always be assured by non-operative treatment following closed reduction (Salter and Dubos 1974). Innominate osteotomy was originally designed for children with delayed presentation of developmental hip dysplasia and those in whom earlier treatment had failed to produce remodeling (Salter 1961). Reorientation of the acetabulum makes the reduced hip more stable, increases the load-bearing area of the acetabulum in the weight-bearing position, and does not alter its shape or volume. Aims of study: 1-Assess the accuracy of pre-operative acetabular index (AI) measure as an indicator of salter osteotomy in comparing with the intraoperative assessment regarding the stability of the hip in children aged (18—36)months. 2-compare the results of open reduction with and without salter’s osteotomy in the management of developmental dysplasia of hip(DDH) in this age group. Patients And Methods: Sixty one patients,(82)hips involved with developmental dysplasia of the hip. they were treated by open reduction with or without salter innominate osteotomy in AL-wasity teaching hospital from November 2015 to November 2017. The mean period of follow up was 17.2 months. we include patients aged 18— 36 months. children with neuromuscular disease and children with recurrent dislocation after previous open reduction were excluded.Of the (61)patients there were(52)girls and (9) boys,(36)bilateral(15 of them operated unilateral and 21 operated bilateral) and (25)unilateral (9 right and 16 left). Results:1–acetabular dysplasia is confirmed when the pre-operative acetabular Index(AI)IS more than 30 , which is found to be a weak indicator for salter’s osteotomy, in contrast with the intraoperative indications of it. 2-The results revealed that the mean value of the acetabular index was significantly reduced(p≤0.05) after one year of surgery with two modalities of surgery, where the mean value of acetabular index was reduced from 33.8 to 27.5 with open reduction technique while it was reduced from 39.7 to 23.1 with salter technique. 3-The results revealed there was a significant difference in the mean value of CEA between the two types of surgeries and that of Salter technique was higher than of open reduction(p-value0.03). 4-The results showed nearly similar outcomes and no significant difference was reported according to MC key when the outcome assessed in term of excellent, good and fair between the open reduction and salter open reduction groups. 5- the postoperative radiological results according to Severin grades are, grade I;1.2%of total (1.8% in group 2),grade II; 85.4%(88.0% in group 1 and 84.2%in group 2), grade III; 9.8% of total(4.0%in group 1 and 12.2% in group 2) and in grade IV; 3.6% of total(8.0% in group 1 and 1.8% in group 2) despite this difference it is not significant (p-value 0.7). 6-The finding showed there was no significant difference(p=0.2) between two modalities of surgery regarding the associated complication. Conclusion:-1-The preoperative radiological measures (AI) which determine acetabular dysplasia, is a weak indicator for the need of salter inomenate osteotomy. 2-the intraoperative test of stability is found to be a reliable indicator for pelvic osteotomy (salter) to achieve a stable hip. 3- Open reduction in association with osteotomy of the iliac bone as described by Salter presented a statistically significant improvement in the angular parameters measured on the patients’ radiographs, from before to after the operation. 4-Reorientation of the acetabulum makes the reduced hip more stable, increases the load-bearing area of the acetabulum in the weight-bearing position. 5-Avascular necrosis (AVN) and residual acetabular dysplasia are the two main complications of developmental dysplasia of the hip (DDH) treatment