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?
Before 1956, surgery for late-presenting congenital hip dislocation meant open reduction with a shelf or buttress procedure above the acetabulum. Salter identified the fundamental error: the problem is not a shallow socket, but a socket pointing the wrong direction.
When you see a child over 18 months with congenital dislocation, Salter's framework dictates the decision: operate between 18 months and 6 years, confirm all six prerequisites, and accept that operating after age 4 cuts your excellent/good rate from 93.6% to 56.7%. For subluxation, the capsule stays closed — osteotomy alone achieves 100% good results in the optimal age window, and the 0% AVN rate in this group confirms why.
For secondary (salvage) cases, set expectations carefully: 30% of children referred after failed prior treatment already have AVN, and the best achievable rate drops to 61.1%.
The 45-year follow-up data (Thomas, Wedge, and Salter, JBJS Am 2007) validated the technique's durability, cementing Salter innominate osteotomy as the benchmark against which Pemberton's pericapsular osteotomy, triple innominate osteotomy, and periacetabular osteotomy are compared.
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?
Before 1956, surgery for late-presenting congenital hip dislocation meant open reduction with a shelf or buttress procedure above the acetabulum. Salter identified the fundamental error: the problem is not a shallow socket, but a socket pointing the wrong direction.
When you see a child over 18 months with congenital dislocation, Salter's framework dictates the decision: operate between 18 months and 6 years, confirm all six prerequisites, and accept that operating after age 4 cuts your excellent/good rate from 93.6% to 56.7%. For subluxation, the capsule stays closed — osteotomy alone achieves 100% good results in the optimal age window, and the 0% AVN rate in this group confirms why.
For secondary (salvage) cases, set expectations carefully: 30% of children referred after failed prior treatment already have AVN, and the best achievable rate drops to 61.1%.
The 45-year follow-up data (Thomas, Wedge, and Salter, JBJS Am 2007) validated the technique's durability, cementing Salter innominate osteotomy as the benchmark against which Pemberton's pericapsular osteotomy, triple innominate osteotomy, and periacetabular osteotomy are compared.