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.
When you operate on a dysplastic hip and the head redislocates anteriorly after reduction, Pemberton's observation explains why: the anterior acetabular defect medial to the anterior inferior iliac spine is a constant feature of dysplasia that standard shelf procedures and open reductions without acetabuloplasty do not address.
The Pemberton osteotomy is the preferred reshaping procedure when the triradiate cartilage is open (roughly ages 1-12), because it uses the cartilage as a living hinge — reducing acetabular volume by wrapping the roof around the femoral head rather than translating the whole socket as the Salter osteotomy does.
Operate before age 4 when you can: the 100% good result rate in that cohort versus 57% good in the 7-12 group makes the age-at-surgery decision as important as the technique itself. If coxa plana develops postoperatively, do not restrict weight-bearing. Pemberton's series shows all cases resolved spontaneously within two years, and none appeared after the two-year mark.
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.
When you operate on a dysplastic hip and the head redislocates anteriorly after reduction, Pemberton's observation explains why: the anterior acetabular defect medial to the anterior inferior iliac spine is a constant feature of dysplasia that standard shelf procedures and open reductions without acetabuloplasty do not address.
The Pemberton osteotomy is the preferred reshaping procedure when the triradiate cartilage is open (roughly ages 1-12), because it uses the cartilage as a living hinge — reducing acetabular volume by wrapping the roof around the femoral head rather than translating the whole socket as the Salter osteotomy does.
Operate before age 4 when you can: the 100% good result rate in that cohort versus 57% good in the 7-12 group makes the age-at-surgery decision as important as the technique itself. If coxa plana develops postoperatively, do not restrict weight-bearing. Pemberton's series shows all cases resolved spontaneously within two years, and none appeared after the two-year mark.