Salter Osteotomy



- Discussion:
    - type of open wedge innominate osteotomy which extends and retroverts acetabulum around fixed axis;
    - osteotomy redirects entire acetabulum so that its roof covers femoral head both anteriorly and superiorly;
            - extends and retroverts acetabulum around fixed axis;
    - in young children, the acetabular deficiency is usually anterior, and therfored the Salter Osteotomy is design to provide coverage anteriorly at the expense of posterior coverage;
            - osteotomy addresses the pathological orientation of the acetabulum (facing more anterolaterally than normal);
            - when hip is extended, femoral head is insufficiently covered anteriorly;
            - when hip is adducted, there is insufficient cover superiorly;
    - this osteotomy also tends to lateralize joint slightly & to lengthen limb;
            - lateralization will have negative effect of increasing joint reactive forces;
    - success of procedure depends on some extent on the flexibility of the symphysis pubis (which decreases w/ age);
    - may expect improvement in the center-edge angle of 10 degrees;
    - outcomes:
            - in the report by Böhm P and Brzuske A, the authors describe their results with the Salter osteotomy;
                    - study included of 61 patients who had seventy-three Salter innominate osteotomies;
                    - mean age of the patients was 4.1 years (range, 1.3 to 8.8 years);
                    - mean duration of follow-up was 30.9 years (range, 26.2 to 35.4 years);
                    - there were seven true revisions (one acetabuloplasty, one triple osteotomy, and five total hip arthroplasties);
                    - w/ true revision as the end point, the cumulative survival rate at 35.3 years was 0.90.
                    - 15 of the seventy-three hips were considered a failure, which was defined as a revision or a Harris hip score of <70 points and/or a Merle d’Aubigné and Postel score of <13 points;
                    - the authors note that when an acetabulum can be most closely restored to a normal configuration without the development of avascular necrosis, good long-term results (lasting for more than thirty years) can be expected;
                            - authors recommend that when open reduction is necessary, that it be perform prior to the Salter innominate osteotomy;
                    - the grade of dislocation at the time of the first examination and immediately preoperatively, the grade of AVN, and the adequacy of surgical correction are important prognostic factors for the long-term clinical result. 
                    - Salter Innominate Osteotomy for the Treatment of Developmental Dysplasia of the Hip in Children. Results of Seventy-three Consecutive Osteotomies After Twenty-six to Thirty-five Years of Follow-up

- Indications:
     - age: 18 months to 6 years;
     - requires a mobile symphysis pubis;
     - useful only when dislocation is reduced (either closed or open reduction) at the time of osteotomy;
     - may be indicated w/ instability after reduction or persistent acetabular dyplasia;
     - not recommended w/ bilateral DDH because it may uncover opposite hip;

- Surgical Considerations:
    - use anterior surgical approach to the hip;
    - adductor and iliopsoas muscles are released;
    - innominate bone is osteotomized with a Gigli saw from the sciatic notch to the anterior inferior iliac spine;
    - entire acetabulum together with the pubis and ischium is rotated as as unit - anteriorly and laterally, w/ the symphysis acting as a hinge;
    - external rotation of the femur opens the osteotomy anteriorly;
    - osteotomy is held open anterolaterally by a wedge of bone, and thus roof of the acetabulum is shifted more anteriorly and laterally;
           - wedge of bone is held with Steinman pins;

- Complications:
     - may lengthen the affected leg up to 1 cm



Modified Salter osteotomy.

The effectiveness of the Salter innominate osteotomy in the treatment of congenital dislocation of the hip.

[Transiliac leg lengthening: experiences with a modified Salter osteotomy]

Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip.
  
The first fifteen year's personal experience with innominate osteotomy in the treatment of congential dislocation and subluxation of the hip.

Salter Innominate Osteotomy for the Treatment of Developmental Dysplasia of the Hip in Children. Results of Seventy-three Consecutive Osteotomies After Twenty-six to Thirty-five Years of Follow-up 



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, August 9, 2012 2:29 pm