Pemberton, J Bone Joint Surg Am 1965 - Pericapsular Osteotomy of the Ilium for Treatment of Congenital Subluxation and Dislocation of the Hip

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Pericapsular Osteotomy of the Ilium for Treatment of Congenital Subluxation and Dislocation of the Hip

Pemberton·J Bone Joint Surg Am·1965·371 citations·Case series

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Pemberton (1965) describes the pericapsular osteotomy of the ilium for congenital hip subluxation and dislocation. The procedure addresses the anterior acetabular defect he identifies as the constant anatomic basis of hip instability. This is a case series of 115 hips in 91 patients with minimum 2-year follow-up, reporting results stratified by age at operation.

Key Findings

Every child under age 4 years achieved a good result — the procedure is easiest to perform and most reliable in this age group, making timing of surgery as important as technique selection.
Results decline sharply with age, underscoring that delaying surgery carries real functional cost:
- Under 4 years: 100% good (46 patients, 64 hips)
- 4–7 years: most good; 4/24 patients fair (all had difficult high dislocations)
- 7–12 years: 12/21 good, 6 fair, 3 poor — including one permanent sciatic palsy and two hips requiring arthroplasty or fusion
The procedure depends on triradiate cartilage plasticity, which defines a firm operative window — too early and the pelvic bone is too soft to hold the displaced roof; too late and the hinge point is gone:
- Lower limit: ~1 year
- Upper limit: 12–14 years
Coxa plana occurred in ~10% of hips (12/115), exclusively after difficult reductions and exclusively within 2 years of surgery; all cases resolved spontaneously without protected weight-bearing or special treatment.
The anterior acetabular defect medial to the anterior inferior iliac spine is a constant anatomic finding in both subluxation and true dislocation, invisible on standard AP radiographs — making clinical examination (palpable anterior femoral head on rotation) an essential diagnostic adjunct.

Board PearlPemberton osteotomy hinges the acetabular roof at the triradiate cartilage to correct the anterior acetabular defect — 100% good results under age 4, worsening significantly after age 7.

Pericapsular Osteotomy of the Ilium for Treatment of Congenital Subluxation and Dislocation of the Hip.

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|

Pericapsular Osteotomy of the Ilium for Treatment of Congenital Subluxation and Dislocation of the Hip

Pemberton·J Bone Joint Surg Am·1965·371 citations·Case series

|

Pemberton (1965) describes the pericapsular osteotomy of the ilium for congenital hip subluxation and dislocation. The procedure addresses the anterior acetabular defect he identifies as the constant anatomic basis of hip instability. This is a case series of 115 hips in 91 patients with minimum 2-year follow-up, reporting results stratified by age at operation.

Key Findings

Every child under age 4 years achieved a good result — the procedure is easiest to perform and most reliable in this age group, making timing of surgery as important as technique selection.
Results decline sharply with age, underscoring that delaying surgery carries real functional cost:
- Under 4 years: 100% good (46 patients, 64 hips)
- 4–7 years: most good; 4/24 patients fair (all had difficult high dislocations)
- 7–12 years: 12/21 good, 6 fair, 3 poor — including one permanent sciatic palsy and two hips requiring arthroplasty or fusion
The procedure depends on triradiate cartilage plasticity, which defines a firm operative window — too early and the pelvic bone is too soft to hold the displaced roof; too late and the hinge point is gone:
- Lower limit: ~1 year
- Upper limit: 12–14 years
Coxa plana occurred in ~10% of hips (12/115), exclusively after difficult reductions and exclusively within 2 years of surgery; all cases resolved spontaneously without protected weight-bearing or special treatment.
The anterior acetabular defect medial to the anterior inferior iliac spine is a constant anatomic finding in both subluxation and true dislocation, invisible on standard AP radiographs — making clinical examination (palpable anterior femoral head on rotation) an essential diagnostic adjunct.

Board PearlPemberton osteotomy hinges the acetabular roof at the triradiate cartilage to correct the anterior acetabular defect — 100% good results under age 4, worsening significantly after age 7.

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