Clinicoradiological outcomes following pembersal acetabular osteotomy for developmental dysplasia of hip in young children: A series of 16 cases followed minimum 2 years

Published:October 22, 2021DOI:https://doi.org/10.1016/j.jcot.2021.101669

      Abstract

      Purpose

      Pembersal acetabular osteotomy is a relatively less practised procedure for developmental dysplasia of hip in young children. We retrospectively studied the acetabular correction and clinico-radiological outcome with this osteotomy in 16 children (16 hips) aged less than 4 years.

      Methods

      Postoperative correction of acetabular dysplasia was measured by acetabular index (AI). At follow up, following radiological parameters were documented: Centre edge angle (CEA), Reimer's index (RI) and acetabular depth to width ratio (D/W ratio). Avascular necrosis of hip, stability, and premature fusion of triradiate cartilage (TRC) were also recorded. Overall containment was assessed by modified Severin classification and function by Mckay clinical grade.

      Results

      The mean age at time of surgery was 25 months. Mean follow up was 54 months. The postoperative AI (17.6 ± 5.6°) improved significantly from preoperative values (37.5 ± 5.0°) (p < 0.0001). Mean follow up AI on the operated side was 15.3 ± 6.9° as compared to 14.7 ± 4.4° on the normal side (p = 0.78). Follow up CEA (24.9 ± 11.3°), Reimer's index (14.3%), D/W ratio (40.9%) did not differ significantly from the normal side. Early closure of TRC was not found in any of hips. All hips were clinically stable. As per modified Severin's classification, 7 hips were Type Ia, 7 Type IIa and 2 had residual dysplasia. Twelve (75%) hips had excellent clinical outcome, 2 (12.5%) good outcome and 2 (12.5%) had fair outcome.

      Conclusions

      Pembersal osteotomy is a safe and effective option for correction of acetabular dysplasia during open reduction of DDH in young children. It improves the AI and femoral head coverage, and promotes formation of a congruent and stable hip joint.

      Keywords

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      References

        • Morrissy R.T.
        Atlas of Orthopaedic Surgery.
        JB Lippincott, Philadelphia1992: 172
        • Perlik P.C.
        • Westin G.W.
        • Marafioti R.L.
        A combination pelvic osteotomy for acetabular dysplasia in children.
        J Bone Joint Surg Am. 1985; 67: 842-850
        • Tavares J.O.
        Modified Pemberton acetabuloplasty for the treatment of congenital hip dysplasia.
        J Pediatr Orthop. 2004; 24: 501-507
        • Bursali A.
        • Tonbul M.
        How are outcomes affected by combining the Pemberton and Salter osteotomies?.
        Clin Orthop Relat Res. 2008; 466: 837-846
        • Sankar W.N.
        • Young C.R.
        • Lin A.G.
        • Crow S.A.
        • Baldwin K.D.
        • Moseley C.F.
        Risk factors for failure after open reduction for DDH: a matched cohort analysis.
        J Pediatr Orthop. 2011; 31: 232-239
        • Wang T.M.
        • Wu K.W.
        • Shih S.F.
        • Huang S.C.
        • Kuo K.N.
        Outcomes of open reduction for developmental dysplasia of the hip: does bilateral dysplasia have a poorer outcome?.
        J Bone Joint Surg Am. 2013; 95: 1081-1086
        • Zadeh H.G.
        • Catterall A.
        • Hashemi-Nejad A.
        • Perry R.E.
        Test of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip.
        J Bone Joint Surg Br. 2000; 82: 17-27
        • McKay D.W.
        Pemberton's innominate osteotomy: indications, technique, results, pitfalls, complications.
        in: Tachdjian M.O. Congenital Dislocation of the Hip. Churchill Livingstone, New York, NY1982: 543-554
        • Tönnis D.
        An evaluation of conservative and operative methods in the treatment of congenital hip dislocation.
        Clin Orthop Relat Res. 1976; 119: 76-88
        • Hilgenreiner W.H.
        Classic. Translation: hilgenreiner on congenital hip dislocation.
        J Pediatr Orthop. 1986; 6: 202-214
        • Omeroglu H.
        • Biçimoglu A.
        • Aguş H.
        • Tümer Y.
        Measurement of center-edge angle in developmental dysplasia of the hip: a comparison of two methods in patients under 20 years of age.
        Skeletal Radiol. 2002; 31: 25-29
        • Reimers J.
        The stability of the hip in children: a radiological study of the results of muscle surgery in cerebral palsy.
        Acta Orthop Scand Suppl. 1980; 184: 1-100
        • Heyman C.H.
        • Herndon C.H.
        Legg-Perthes disease: a method for the measurement of the roentgenographic results.
        J Bone Joint Surg Am. 1950; 32: 767-778
        • Severin E.
        Congenital dislocation of the hip: development of the hip after reduction.
        J Bone Joint Surg Am. 1950; 32: 507-518
        • Merckaert S.R.
        • Zambelli P.Y.
        • Edd S.N.
        • Daniele S.
        • Brigitte J.
        Mid and long-term outcome of Salter's, Pemberton's and Dega's osteotomy for treatment of developmental dysplasia of the hip: a systematic review and meta-analysis.
        Hip Int. 2020; (1120700020942866)https://doi.org/10.1177/1120700020942866
        • Kalamchi A.
        • MacEwen G.D.
        Avascular necrosis following treatment of congenital dislocation of the hip.
        J Bone Joint Surg Am. 1980; 62: 876-888
        • Salter R.B.
        Role of innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip in the older child.
        J Bone Joint Surg Am. 1966; 48: 1413-1439
        • Ertürk C.
        • Altay M.A.
        • Işikan U.E.
        A radiological comparison of Salter and Pemberton osteotomies to improve acetabular deformations in developmental dysplasia of the hip.
        J Pediatr Orthop B. 2013; 22: 527-532
        • Aksoy C.
        • Yilgor C.
        • Demirkiran G.
        • Caglar O.
        Evaluation of acetabular development after Dega acetabuloplasty in developmental dysplasia of the hip.
        J Pediatr Orthop B. 2013; 22: 91-95
        • Leet A.I.
        • Mackenzie W.G.
        • Szoke G.
        • Harcke H.T.
        Injury to the growth plate after Pemberton osteotomy.
        J Bone Joint Surg Am. 1999; 81: 169-176