Salter innominate osteotomy

1
Salter innominate osteotomy for avascular
necrosis following treatment of developmental
dysplasia of the hip
Shinichi Satsuma MD, Daisuke Kobayashi
MD, Sayaka Hamamura MD.
Department of Orthopaedic Surgery, Kobe
Childrens Hospital, Hyogo, Japan
2
PURPOSE
To assess the efficiency of Salter innominate
osteotomy for avascular necrosis (AVN)
following treatment of developmental dysplasia
of the hip (DDH)
3
29 patients
Sex 27 women, 2 men Affected side 12 right
hips, 17 left hips Mean age at follow-up 19
years old (range, 14 to 24)
Group A 17 patients Insult only in
the proximal femoral epiphysis Salter
innominate osteotomy (SA) Group B 4
patients Insult only in the proximal
femoral epiphysis Salter innominate
osteotomy (SA) - Group C 8 patients
Insult both in the proximal femoral epiphysis
and metaphysis, Salter innominate
osteotomy (SA)

• center-edge angle (CEA)
• Sharps acetabular angle
• acetabular-head index (AHI)
• articulo-trochanteric distance (ATD)
• Stulbergs criteria
• Severins criteria

4
CE angle between the affected and unaffected
side in each group
Sharps acetabular angle between the affected and
unaffected side in each group
P lt 0.01
25.2
24.5
21.5
31
11
21.6
Group A
Group C
Group B
AHI between the affected and unaffected side in
each group
ATD between the affected and unaffected side in
each group
P lt 0.01
P lt 0.05
P lt 0.05
P lt 0.01
P lt 0.05
14.9
23.9
- 0.86
22.7
5.8
19.9
Group A
Group C
Group B
5
Group A
Group C
Group B
?
?
Group?
?
Group?
Group?
?
Group?
?
Group?or ? 88.2
Group?or ? 75
Group?or ? 50
6
first visit 4 months of age
Stulberg ? Severin ?b
final follow-up 22y4m
SA
7
Stulberg ? Severin ?
first visit 7 months of age
Reposition by OR
final follow-up 21y6m
3y7m
5y8m pre op.
5y10m 2 months after op.
SA
8
AVN of the femoral head
Growth disturbance of the proximal femoral
physis
Aspherical femoral head
Dysplastic acetabulum
Incongruent hip joint
improve the orientation in a dysplastic hip
improve containment and Subsequent remodeling
in Legg-Calvé-Perthes disease
Salters innominate osteotomy
9
GroupA
GroupC
GroupB
INDEX
CEA Sharp AHI Severin
? ? ? ?
? ? ? ?
? ?
good acetabulum
congruent hip joint
? ?
CEA Severin
? ?

normal growth of the proximal femoral physis
?


ATD Stulberg
spherical femoral head
Stulberg
?


10
CONCLUSION
When ischemic insult is limited to the proximal
femoral epiphysis, Salter innominate osteotomy
should mold the femoral head spherically and
form a good acetabulum.