Long-term outcome after anterolateral open reduction and Salter osteotomy for late presenting developmental dysplasia of the hip

• Published in: Journal of children's orthopaedics Vol. 12; no. 4; pp. 364 - 368
• Main Author: Thomas, S. R. Y. W.
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.08.2018; Sage Publications Ltd; The British Editorial Society of Bone & Joint Surgery
• Subjects: Age; Arthritis; Closed reduction; Current Concepts Review; Hip dislocation; Hip joint; Joint surgery; Orthopedics; Osteoarthritis; Pediatrics; United States > US; Iowa; dysplasia; hip; open reduction
• ISSN: 1863-2521; 1863-2548
• DOI: 10.1302/1863-2548.12.180076

Introduction Only a handful of studies report outcomes after open reduction for developmental hip dislocation beyond skeletal maturity. For successfully reduced hips it is the outcome into late adulthood on which the results of this intervention should be judged. These studies indicate clearly the importance of preservation of the acetabular growth centres during surgery. The acetabulum must also be addressed when insufficient growth remains reliably to remodel residual dysplasia even after stable, concentric reduction. Summary Comparing the longest-term outcome studies for open reduction to less invasive, but mainly historical, techniques of gradual traction reduction it is unsettling to note that the latter protocols are associated with the best results. Whereas open reduction and innominate osteotomy are practised as originally described by Salter, gradual traction reduction has largely been abandoned. Conclusions There are probably aspects of the more time-consuming methods of gradual reduction that do not violate the hip joint capsule that expose the femoral head to a lower risk of femoral head osteonecrosis leading to better long-term outcomes.