Salter vs Pemberton: Comparative Radiologic Analysis of Changes in the Acetabulum and Pelvis After Surgical Correction in Children with Hip Dysplasia

Abstract

Background. Hip dysplasia, characterized by pronounced anatomical changes, continues to be one of the leading positions in the structure of all congenital malformations of the musculoskeletal system. Late diagnosis or ineffective conservative treatment leads to the need for surgical correction of congenital deformities of the proximal femur and acetabulum. The choice of the method of operational reconstruction of the latter remains a subject of discussion over the past decades. Aim of the study a comparative X-ray analysis of surgical treatment outcomes of children with hip dysplasia type IHDI IIIIV after Salter and Pemberton pelvic osteotomies. Methods. The study included 80 patients (80 hip joints) aged 2 to 4 years (3.10.45) with hip dysplasia of the IIIIV degree according to the IHDI. Patients were divided into two groups: group I consisted of 40 patients who underwent modified Salter osteotomy, group II 40 patients who underwent Pemberton pericapsular acetabuloplasty. Radiometry of the following parameters was performed: acetabular index (AI), Wiberg angle, neck-shaft angle, anteversion angle of the proximal femur, degree of bone coverage, the depth of the acetabulum (AD) and pelvic height (PH) Results. The values of AI and Wiberg angle in patients in I group indicate that a greater correction was achieved (p0.05) in contrast to patients who underwent Pemberton pericapsular acetabuloplasty. At the same time, the values of AD and PH in I group patients had pronounced differences (p0.05) from those in II group patients, whose values were close to similar indicators in the contralateral hip joint. Conslusions. In the treatment of children with hip dysplasia IHDI III-IV degree performing a modified Salter osteotomy leads to a significant decrease in the values of AI and an increase in the values of the Wiberg angle, which corresponds to hypercorrection of the position of the acetabulum, does not affect the AD and contributes to the elongation of the hemipelvis by an average of 13.8 mm. Pemberton acetabuloplasty allows to achieve values of AI and Wiberg angle close to the age-related indicators of the norm, leads to an increase AD, approaching the contralateral joint in its value and does not significantly affect the PH.