Salter, Clin Orthop Relat Res 1974 - The First Fifteen Year's Personal Experience with Innominate Osteotomy in the Treatment of Congenital Dislocation and Subluxation of the Hip - Article Summary

The First Fifteen Year's Personal Experience with Innominate Osteotomy in the Treatment of Congenital Dislocation and Subluxation of the Hip

Salter, Dubos·Clin Orthop Relat Res·1974·295 citations·Case series

This paper reports Salter's 15-year personal series of 250 patients (325 hips) treated with innominate osteotomy for congenital hip dislocation and subluxation between 1958 and 1968. It defines the procedure's rationale, six surgical prerequisites, contraindications, and Severin-graded radiographic outcomes. The central question: what results can be expected — and what errors explain failures — when this technique is applied systematically?

Key Findings

Primary dislocation treated with combined open reduction and innominate osteotomy achieved 93.6% excellent/good in children aged 1.5-4 years (110 hips), falling to 56.7% in children aged 4-10 years (30 hips); the authors still set the upper age limit for dislocation at approximately 6 years.
Primary subluxation treated with osteotomy alone (no open reduction) achieved 100% excellent/good in ages 1.5-4 years and 91.6% in ages 4-16 years.
- Subluxation is by far the best indication for this procedure, and because no open reduction is needed these results reflect innominate osteotomy alone.
Secondary operations (after failed prior treatment) achieved only 61.1% excellent/good results.
- 30% of these children entered surgery with pre-existing AVN from prior treatment.
- The takeaway: the best time to treat a congenital hip is the first time.
AVN occurred in 5.7% after combined open reduction and osteotomy, but 0% after osteotomy alone (capsule not opened).
- The authors suggest AVN is a complication of open reduction rather than of the osteotomy itself.
Six prerequisites must ALL be met before surgery:
- 1. Femoral head brought opposite the acetabulum (traction if needed)
- 2. Adductor and iliopsoas contractures released
- 3. Complete, concentric reduction in the true acetabulum
- 4. Reasonable joint congruity
- 5. Good range of motion (abduction, IR, flexion)
- 6. Correct patient age
- Absence of any single prerequisite is a definite contraindication.

Board PearlAfter primary combined open reduction and innominate osteotomy for congenital dislocation, excellent/good results fell from 93.6% at ages 1.5-4 years to 56.7% at ages 4-10 years; Salter's upper age limit for dislocation was approximately 6 years.

Supplemental

The First Fifteen Year's Personal Experience with Innominate Osteotomy in the Treatment of Congenital Dislocation and Subluxation of the Hip.

Salter, DubosClin Orthop Relat Res1974295 citationsCase series