This paper reports Salter's personal experience applying innominate (pelvic) osteotomy to young adults with residual congenital hip subluxation. The procedure, originally designed for children, is extended to patients up to the fifth decade to prevent or arrest early secondary degenerative arthritis. It defines the strict indications, prerequisites, and contraindications that determine who is a candidate.
The core decision rule: in a young adult with residual subluxation, correct the acetabular side before cartilage loss becomes irreversible. The acetabulum is usually more abnormal than the femur, so three-dimensional acetabular redirection addresses the true pathology better than a femoral osteotomy.
Selection is everything. The four prerequisites (true acetabulum, congruity, at least half-normal cartilage space, at least 60% of normal motion) must all be present. Missing any one is a contraindication.
The biomechanical rationale is testable: subluxation concentrates load on the anterolateral acetabulum, driving subchondral sclerosis and cartilage breakdown. Redirection lowers pressure per unit area and can arrest or partially reverse early disease. When a patient has advanced arthritis or fails these criteria, the Chiari medial displacement osteotomy is the salvage alternative for pain relief.
This paper reports Salter's personal experience applying innominate (pelvic) osteotomy to young adults with residual congenital hip subluxation. The procedure, originally designed for children, is extended to patients up to the fifth decade to prevent or arrest early secondary degenerative arthritis. It defines the strict indications, prerequisites, and contraindications that determine who is a candidate.
The core decision rule: in a young adult with residual subluxation, correct the acetabular side before cartilage loss becomes irreversible. The acetabulum is usually more abnormal than the femur, so three-dimensional acetabular redirection addresses the true pathology better than a femoral osteotomy.
Selection is everything. The four prerequisites (true acetabulum, congruity, at least half-normal cartilage space, at least 60% of normal motion) must all be present. Missing any one is a contraindication.
The biomechanical rationale is testable: subluxation concentrates load on the anterolateral acetabulum, driving subchondral sclerosis and cartilage breakdown. Redirection lowers pressure per unit area and can arrest or partially reverse early disease. When a patient has advanced arthritis or fails these criteria, the Chiari medial displacement osteotomy is the salvage alternative for pain relief.