Study on Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy in treatment of Tönnis type <b>Ⅲ</b> and <b>Ⅳ</b> developmental dysplasia of the hip in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Timin ¹ , LI Ping ¹ , ZHOU Jinlei ¹ ,  SI Haibo ²

1. Department of Orthopedics, the People’s Hospital of Xizang Autonomous Region, Lhasa Xizang, 850000, P. R. China;
2. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

SI Haibo, Email: sihaibo@wchscu.cn

Keywords：

Developmental dysplasia of the hip; Salter osteotomy; subtrochanteric shortening and derotational osteotomy; surgical timing; children

DOI：

10.7507/1002-1892.202408069

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Objective To investigate the effectiveness of Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy in treating Tönnis type Ⅲ and Ⅳ developmental dysplasia of the hip (DDH) in children and explore the urgical timing. Methods A retrospective collection was performed for 74 children with Tönnis type Ⅲ and Ⅳ DDH who were admitted between January 2018 and January 2020 and met the selection criteria, all of whom were treated with Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy. Among them, there were 38 cases in the toddler group (age, 18-36 months) and 36 cases in the preschool group (age, 36-72 months). There was a significant difference in age between the two groups (P<0.05), and there was no significant difference in gender, side, Tönnis typing, and preoperative acetabular index (AI) (P>0.05). During follow-up, hip function was assessed according to the Mckay grade criteria; X-ray films were taken to observe the healing of osteotomy, measure the AI, evaluate the hip imaging morphology according to Severin classification, and assess the occurrence of osteonecrosis of the femoral head (ONFH) according to Kalamchi-MacEwen (K&M) classification criteria. Results All operations of both groups were successfully completed, and the incisions healed by first intention. All children were followed up 14-53 months, with an average of 27.9 months. There was no significant difference in the follow-up time between the two groups (P>0.05). At last follow-up, the excellent and good rates according to the Mckay grading were 94.73% (36/38) in the toddler group and 83.33% (30/36) in the preschool group, and the difference between the two groups was significant (P<0.05). The imaging reexamination showed that all osteotomies healed with no significant difference in the healing time between the two groups (P>0.05). There was no significant difference in AI between the two groups at each time point after operation (P>0.05), and the AI in the two groups showed a significant decreasing trend with time extension (P<0.05). The result of Severin classification in the toddler group was better than that in the preschool group at last follow-up (P<0.05). There was no significant difference in the incidence of ONFH between the two groups (P>0.05). In the toddler group, 2 cases were K&M type Ⅰ; in the preschool group, 3 were type Ⅰ, and 1 type Ⅱ. There was no dislocation after operation.Conclusion Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy is an effective way to treat Tönnis type Ⅲ and Ⅳ DDH in children, and surgical interventions for children aged 18-36 months can achieve better results.

Citation： YANG Timin, LI Ping, ZHOU Jinlei, SI Haibo. Study on Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy in treatment of Tönnis type Ⅲ and Ⅳ developmental dysplasia of the hip in children. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(2): 168-173. doi: 10.7507/1002-1892.202408069 Copy

1.	Meng XH, Weng YT, Rao Y, et al. Two genetic variants in the HIBCH and FTCDNL1 genes are associated with susceptibility to developmental dysplasia of the hips among the Han Chinese population of Southwest China. J Orthop Surg Res, 2024, 19(1): 464. doi: 10.1186/s13018-024-04958-8.
2.	Wu Q, Li Y, Lin Y, et al. Risk factor analysis of femoral avascular necrosis after operation for Tönnis grade Ⅳ developmental dysplasia of the hip. Int Orthop, 2024, 48(4): 1011-1016.
3.	吐尔孙塔依·吐尔汗, 曹力, 陈良, 等. 两种髋人类位髋人字石膏治疗婴幼儿髋关节发育不良比较. 中国矫形外科杂志, 2023, 31(12): 1092-1096.
4.	陈述, 燕华, 吴伟平, 等. 骨盆截骨术治疗发育性髋关节发育不良的研究进展. 中国矫形外科杂志, 2020, 28(3): 244-247.
5.	庞浩田, 王亦维, 范民杰, 等. 三维打印个体化手术导航模板在发育性髋关节发育不良手术中的应用. 中华小儿外科杂志, 2022, 43(4): 365-372.
6.	Böhm P, Brzuske A. Salter innominate osteotomy for the treatment of developmental dysplasia of the hip in children: results of seventy-three consecutive osteotomies after twenty-six to thirty-five years of follow-up. J Bone Joint Surg (Am), 2002, 84(2): 178-186.
7.	Badrinath R, Orner C, Bomar JD, et al. Narrative review of complications following DDH treatment. Indian J Orthop, 2021, 55(6): 1490-1502.
8.	Liu C, Wang K, Tang Z, et al. Effects of different pelvic osteotomy surgeries on acetabular center and pelvic morphology. J Orthop Surg Res, 2023, 18(1): 568. doi: 10.1186/s13018-023-04062-3.
9.	Butler J, Singleton A, Miller R, et al. Bikini incision vs longitudinal incision for anterior total hip arthroplasty: a systematic review. Arthroplasty Today, 2022, 17: 1-8.
10.	McKay DW. A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clin Orthop Relat Res, 1974(98): 124-132.
11.	Ward WT, Vogt M, Grudziak JS, et al. Severin classification system for evaluation of the results of operative treatment of congenital dislocation of the hip. A study of intraobserver and interobserver reliability. J Bone Joint Surg (Am), 1997, 79(5): 656-663.
12.	Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg (Am), 1980, 62(6): 876-888.
13.	Bakarman K, Alsiddiky AM, Zamzam M, et al. Developmental dysplasia of the hip (DDH): etiology, diagnosis, and management. Cureus. 2023, 15(8): e43207. doi: 10.7759/cureus.43207.
14.	Li Y, Guo Y, Li M, et al. Acetabular index is the best predictor of late residual acetabular dysplasia after closed reduction in developmental dysplasia of the hip. Int Orthop, 2018, 42(3): 631-640.
15.	Li Y, Zhou Q, Liu Y, et al. Closed reduction and dynamic cast immobilization in patients with developmental dysplasia of the hip between 6 and 24 months of age. Eur J Orthop Surg Traumatol, 2019, 29(1): 51-57.
16.	Tachibana T, Fujii M, Kitamura K, et al. Does acetabular coverage vary between the supine and standing positions in patients with hip dysplasia? Clin Orthop Relat Res, 2019, 477(11): 2455-2466.
17.	Salter RB. Role of innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip in the older child. J Bone Joint Surg (Am), 1966, 48(7): 1413-1439.
18.	Vasyl S, Viktor F. Modified Salter pelvic osteotomy for the DDH treatment. Acta Ortop Bras. 2023, 31(spe1): e259040. doi: 10.1590/1413-785220233101e259040.
19.	林天烨, 杨鹏, 熊冰朗, 等. 术中画线法与三维重建术前模拟测量股骨截骨旋转角度对比的体外实验. 中国组织工程研究, 2021, 25(21): 3349-3353.
20.	Desai VM, Hall CE, Cardin S, et al. Prevalence and risk factors for stiffness following open reduction for developmental dysplasia of the hip. J Pediatr Orthop, 2024, 44(10): e908-e914.
21.	陈国平, 江建中, 谢兆林, 等. Salter骨盆截骨+股骨转子下短缩旋转截骨术治疗儿童发育性髋脱位. 临床骨科杂志, 2019, 22(5): 550-553.
22.	Chen Q, Deng Y, Fang B. Outcome of one-stage surgical treatment of developmental dysplasia of the hip in children from 1.5 to 6 years old. A retrospective study. Acta Orthop Belg, 2015, 81(3): 375-383.
23.	Köroğlu C, Özdemir E, Çolak M, et al. Open reduction and Salter innominate osteotomy combined with femoral osteotomy in the treatment of developmental dysplasia of the hip: comparison of results before and after the age of 4 years. Acta Orthop Traumatol Turc, 2021, 55(1): 28-32.
24.	Merckaert S, Zambelli PY. Treatment perspective after failed open reduction of congenital hip dislocation. A systematic review. Front Pediatr, 2023, 11: 1146332. doi: 10.3389/fped.2023.1146332.
25.	Sacks H, Pargas-Colina C, Masrouha K, et al. Outcomes of treatment for developmental dislocation of the hip when the Pavlik method has failed. J Pediatr Orthop B, 2024, 33(5): 420-425.
26.	荀福兴, 黎艺强, 李敬春, 等. Salter截骨对残余髋臼发育不良患儿下肢运动学的影响. 中华小儿外科杂志, 2022, 43(9): 827-834.
27.	Tazi Charki M, Abdellaoui H, Atarraf K, et al. Surgical treatment of developmental dysplasia of the hip in children—A monocentric study about 414 hips. SICOT J, 2022, 8: 29. doi: 10.1051/sicotj/2022030.
28.	Bhatti A, Kumar J, Butt SA. Outcome of one stage combined open reduction, pelvic and derotation femoral osteotomy in congenital dislocated hips of children younger than three years age. J Pak Med Assoc, 2014, 64(9): 1015-1020.
29.	Yong M, Xu M, Lou Y, et al. Risk factors for postoperative avascular necrosis of the femoral head in children with developmental dysplasia of the hip. Front Pediatr. 2023, 11: 1089341. doi: 10.3389/fped.2023.1089341.
30.	Shee BW, Huang SC, Liu TK. One-stage correction of neglected congenital dislocation of the hip without preoperative traction. J Formos Med Assoc, 1993, 92(8): 729-736.

1. Meng XH, Weng YT, Rao Y, et al. Two genetic variants in the HIBCH and FTCDNL1 genes are associated with susceptibility to developmental dysplasia of the hips among the Han Chinese population of Southwest China. J Orthop Surg Res, 2024, 19(1): 464. doi: 10.1186/s13018-024-04958-8.
2. Wu Q, Li Y, Lin Y, et al. Risk factor analysis of femoral avascular necrosis after operation for Tönnis grade Ⅳ developmental dysplasia of the hip. Int Orthop, 2024, 48(4): 1011-1016.
3. 吐尔孙塔依·吐尔汗, 曹力, 陈良, 等. 两种髋人类位髋人字石膏治疗婴幼儿髋关节发育不良比较. 中国矫形外科杂志, 2023, 31(12): 1092-1096.
4. 陈述, 燕华, 吴伟平, 等. 骨盆截骨术治疗发育性髋关节发育不良的研究进展. 中国矫形外科杂志, 2020, 28(3): 244-247.
5. 庞浩田, 王亦维, 范民杰, 等. 三维打印个体化手术导航模板在发育性髋关节发育不良手术中的应用. 中华小儿外科杂志, 2022, 43(4): 365-372.
6. Böhm P, Brzuske A. Salter innominate osteotomy for the treatment of developmental dysplasia of the hip in children: results of seventy-three consecutive osteotomies after twenty-six to thirty-five years of follow-up. J Bone Joint Surg (Am), 2002, 84(2): 178-186.
7. Badrinath R, Orner C, Bomar JD, et al. Narrative review of complications following DDH treatment. Indian J Orthop, 2021, 55(6): 1490-1502.
8. Liu C, Wang K, Tang Z, et al. Effects of different pelvic osteotomy surgeries on acetabular center and pelvic morphology. J Orthop Surg Res, 2023, 18(1): 568. doi: 10.1186/s13018-023-04062-3.
9. Butler J, Singleton A, Miller R, et al. Bikini incision vs longitudinal incision for anterior total hip arthroplasty: a systematic review. Arthroplasty Today, 2022, 17: 1-8.
10. McKay DW. A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clin Orthop Relat Res, 1974(98): 124-132.
11. Ward WT, Vogt M, Grudziak JS, et al. Severin classification system for evaluation of the results of operative treatment of congenital dislocation of the hip. A study of intraobserver and interobserver reliability. J Bone Joint Surg (Am), 1997, 79(5): 656-663.
12. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg (Am), 1980, 62(6): 876-888.
13. Bakarman K, Alsiddiky AM, Zamzam M, et al. Developmental dysplasia of the hip (DDH): etiology, diagnosis, and management. Cureus. 2023, 15(8): e43207. doi: 10.7759/cureus.43207.
14. Li Y, Guo Y, Li M, et al. Acetabular index is the best predictor of late residual acetabular dysplasia after closed reduction in developmental dysplasia of the hip. Int Orthop, 2018, 42(3): 631-640.
15. Li Y, Zhou Q, Liu Y, et al. Closed reduction and dynamic cast immobilization in patients with developmental dysplasia of the hip between 6 and 24 months of age. Eur J Orthop Surg Traumatol, 2019, 29(1): 51-57.
16. Tachibana T, Fujii M, Kitamura K, et al. Does acetabular coverage vary between the supine and standing positions in patients with hip dysplasia? Clin Orthop Relat Res, 2019, 477(11): 2455-2466.
17. Salter RB. Role of innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip in the older child. J Bone Joint Surg (Am), 1966, 48(7): 1413-1439.
18. Vasyl S, Viktor F. Modified Salter pelvic osteotomy for the DDH treatment. Acta Ortop Bras. 2023, 31(spe1): e259040. doi: 10.1590/1413-785220233101e259040.
19. 林天烨, 杨鹏, 熊冰朗, 等. 术中画线法与三维重建术前模拟测量股骨截骨旋转角度对比的体外实验. 中国组织工程研究, 2021, 25(21): 3349-3353.
20. Desai VM, Hall CE, Cardin S, et al. Prevalence and risk factors for stiffness following open reduction for developmental dysplasia of the hip. J Pediatr Orthop, 2024, 44(10): e908-e914.
21. 陈国平, 江建中, 谢兆林, 等. Salter骨盆截骨+股骨转子下短缩旋转截骨术治疗儿童发育性髋脱位. 临床骨科杂志, 2019, 22(5): 550-553.
22. Chen Q, Deng Y, Fang B. Outcome of one-stage surgical treatment of developmental dysplasia of the hip in children from 1.5 to 6 years old. A retrospective study. Acta Orthop Belg, 2015, 81(3): 375-383.
23. Köroğlu C, Özdemir E, Çolak M, et al. Open reduction and Salter innominate osteotomy combined with femoral osteotomy in the treatment of developmental dysplasia of the hip: comparison of results before and after the age of 4 years. Acta Orthop Traumatol Turc, 2021, 55(1): 28-32.
24. Merckaert S, Zambelli PY. Treatment perspective after failed open reduction of congenital hip dislocation. A systematic review. Front Pediatr, 2023, 11: 1146332. doi: 10.3389/fped.2023.1146332.
25. Sacks H, Pargas-Colina C, Masrouha K, et al. Outcomes of treatment for developmental dislocation of the hip when the Pavlik method has failed. J Pediatr Orthop B, 2024, 33(5): 420-425.
26. 荀福兴, 黎艺强, 李敬春, 等. Salter截骨对残余髋臼发育不良患儿下肢运动学的影响. 中华小儿外科杂志, 2022, 43(9): 827-834.
27. Tazi Charki M, Abdellaoui H, Atarraf K, et al. Surgical treatment of developmental dysplasia of the hip in children—A monocentric study about 414 hips. SICOT J, 2022, 8: 29. doi: 10.1051/sicotj/2022030.
28. Bhatti A, Kumar J, Butt SA. Outcome of one stage combined open reduction, pelvic and derotation femoral osteotomy in congenital dislocated hips of children younger than three years age. J Pak Med Assoc, 2014, 64(9): 1015-1020.
29. Yong M, Xu M, Lou Y, et al. Risk factors for postoperative avascular necrosis of the femoral head in children with developmental dysplasia of the hip. Front Pediatr. 2023, 11: 1089341. doi: 10.3389/fped.2023.1089341.
30. Shee BW, Huang SC, Liu TK. One-stage correction of neglected congenital dislocation of the hip without preoperative traction. J Formos Med Assoc, 1993, 92(8): 729-736.

Chinese Journal of Reparative and Reconstructive Surgery

Study on Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy in treatment of Tönnis type Ⅲ and Ⅳ developmental dysplasia of the hip in children

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