Salter pelvic osteotomy

What is a salter pelvic osteotomy?

This is a surgery to help correct a hip socket that is too shallow or has a different shape. A surgeon makes a cut on the outside of the hip and realigns the pelvic bone so that the socket can cover the ball of the hip joint better.

Generally, this surgery should be done before a child starts school. The surgery can be done later if your surgeon judges your child’s bone is still growing and could benefit from the surgery.

Sometimes, a pelvic osteotomy is paired with another surgery to replace the ball in the socket (open reduction of the hip joint). Both surgeries are usually needed in children over 2 years old who have a dislocated hip. Most of the time, this surgery is done years after the dislocated hip was successfully realigned. A possible reason is poor development of the ball-in-socket joint.

Who will need this surgery?

It is not possible to predict which children will need this surgery. Kids who need the surgery don’t necessarily have any symptoms different from kids with dislocated hip who don’t need it.

For that reason, the child’s provider will check in at regular intervals with X-rays to make sure the bone is developing normally. If there is steady improvement of the maturity of the involved hip, surgery generally is not recommended. If there is a plateau in improvement or worsening of radiographic indices, surgery may be recommended.

It has been shown that adults requiring hip replacement surgery often trace their troubles to childhood hip problems, such as dislocated hip.
Improving the hip early in life is aimed at delaying or preventing the need for this surgery. By improving the shape of the socket, we intend make the hip have near normal anatomy before skeletal maturity. That will improve the longevity of your child’s natural hip.

Follow up

The surgery takes less than an hour to perform, but requires a cast. When the time for anesthesia and casting is included, the surgery lasts about 2 to 2.5 hours. Your child will stay at the hospital at least one night.

Don’t force walking, but allow it if your child tries to walk. We will provide information on how to take care of your child in this cast, called a hip spica cast.

The cast is left in place for 4 to 6 weeks and is removed during an office visit. Sometimes the cast is left on longer if your provider performs additional procedures.

There are pins in the pelvis, which are usually removed in the operating room between 6 and 8 weeks later. During that time, dye is sometimes injected into the hip to show hip-alignment improvement and changes after the osteotomy. This is an outpatient procedure, so your child goes home the same day. After removal of the cast, your child may wear a brace at night every night, for as long as your surgeon feels is necessary. The decision is generally based on improvement shown in X-rays.

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