[Pelvic osteotomies in children and adolescents]

Abstract

The main types of pelvic osteotomies in children and adolescents are reviewed. Osteotomies in the first group aim at reorienting the acetabulum: Salter's innominate osteotomy is widely used; its technique, possible drawbacks and indications are analyzed; double and triple osteotomies are then reviewed (Sutherland, Le Coeur, Steel, Tönnis and Trousseau) with their prerequisites, drawbacks and specific indications. A second group of osteotomies do not involve complete transsection of the hemipelvis; they are acetabuloplasties following the techniques described by Dega and by Pemberton, the indications of which are also presented together with their prerequisites. Last comes Chiari's osteotomy: it appears as a palliative operation, with limited indications in children and adolescents. Finally, the indications for pelvic osteotomies are reviewed, according to patient's age, anatomical status of the hip and underlying pathology. Unstable and dysplastic DDH hips may be treated by Salter's osteotomy, Pemberton's acetabuloplasty of triple pelvic osteotomy if the hip is mobile, well centered and congruous. The more simple Salter and Pemberton operations are to be preferred to triple osteotomy as long as they are indicated, i.e. until the age of 5 to 8 years. Established congenital dislocations may be treated using Chiari's osteotomy in cases where a reorientation osteotomy or acetabuloplasty is no longer indicated, provided the hip remains mobile. The indications for pelvic osteotomy in Perthes disease are analyzed, and the arguments for a pelvic rather than femoral osteotomy in some cases are presented. Pelvic osteotomies with the numerous techniques developed over the years, have been a major advance in the treatment of hip anomalies in children. In older adolescents, their indication must be balanced against those of hip reconstruction; they must anyway never make subsequent arthroplasty in adult age difficult or impossible.