Surgical Results and Complications of Developmental Dysplasia of the Hip - One Stage Open Reduction and Salter’s Osteotomy for Patients between 1 and 3 Years Old

Background: Reports of the efficacy of Salter’s osteotomy have often been based ongroups of patients with complex disease conditions and treatment. The purposesof this study were to document the results of patients with well-definedconditions, focusing on the onset and sequelae of osteonecrosis.Methods: The study participants consisted of 63 patients with unilateral hip dislocationwho had undergone one-stage open reduction and Salter’s innominateosteotomy between the ages of 1 and 3 years. The results were evaluatedclinically by McKay’s classification and radiologically by the modifiedSeverin’s classification. Early signs of osteonecrosis were identified by neckwidening, epiphysis fragmentation, and presence of a metaphyseal growthdisturbance line in the first year after the operation.Results: After a follow-up of 10 years on average, good clinical and radiographicresults were noted in 89% and 92% of the patients, respectively.Osteonecrosis occurred in 30 hips, of which 14 subsequently developedfemoral head deformity. Residual dysplasia was noted in 5 hips, mostlyresulting from late-onset coxa valga. Eighty-five percent of the hips withoutosteonecrosis and 53% of the hips with osteonecrosis (p < 0.05) were classifiedas Severin class 1. No pre-operative factors were found to be associatedwith the occurrence of osteonecrosis.Conclusion: One-stage open reduction and Salter’s osteotomy was an effective treatmentfor developmental dysplasia of the hip after walking age. However, parentsmust be informed of the two major complications, osteonecrosis and residualdysplasia, that can lead to long-term morbidity.