An osteotomy is a surgical procedure that involves cutting and reshaping a bone. Pelvic osteotomy is a specific type of osteotomy that involves reorienting or restructuring the hip socket (acetabulum) to better fit the head of the thigh bone (femur). This procedure is done to reduce pain, improve movement, and prevent hip joint injuries.

Indications

This surgery is often performed to correct acetabular dysplasia, which is the poor development of the hip socket. Dysplasia can lead to increased stress on the joint, causing pain, limping, degenerative joint disease, and dislocation. By enhancing the contact area between the femoral head and the acetabulum, a pelvic osteotomy can distribute stress more appropriately over a larger area.

Pelvic osteotomy is indicated for various hip disorders, including:

• Developmental dysplasia of the hip
• Subluxation and dislocation
• Avascular necrosis of the capital femoral epiphyses
• Legg-Calvé-Perthes disease
• Neuromuscular hip instability

Types of Pelvic Osteotomy

Pelvic osteotomies are classified into three main categories, and the specific procedure used depends on the patient's anatomy, maturity, and underlying disease.

• Redirectional Osteotomies: These procedures alter the orientation of the acetabulum. Salter Osteotomy: Recommended for children aged 18 months to 6 years, this procedure involves making a cut in the iliac bone and rotating the pelvic fragment to position the acetabulum over the femoral head. A wedge of bone is inserted and secured with wires to maintain the corrected position. Steel Osteotomy: Used for severe cases of dysplasia, this is a more complex procedure involving three separate osteotomies in the ilium, ischium, and pubic ramus to reposition the acetabulum.
• Reshaping Osteotomies: These procedures change the shape and volume of the acetabulum. Pemberton Osteotomy: Ideal for moderate to severe bilateral hip dysplasia in children under 6 years old, this procedure involves rotating the acetabulum downwards to increase the depth of the socket and cover the femoral head. A bone wedge is used to hold the new position.
• Salvage or Augmentation Osteotomies: These are used to improve the coverage of the femoral head.
• Chiari Osteotomy: A salvage procedure for severe acetabular dysplasia in children over 10 years old who have not responded to other treatments. The ilium is cut, and the acetabulum is displaced medially, with a part of the ilium supporting the femoral head and forming a new shelf over it.

Post-Operative Care

After the surgery, a child will be placed in a hip spica cast to immobilize the hip joint and will stay in the hospital for several days. Weight-bearing should be avoided, and the child will need help with daily activities. Pain medication and antibiotics will be administered, and a physical therapist will provide instructions to help the child regain function gradually.

Risks and Complications

While pelvic osteotomies are the best option for hip dysplasia, rare complications can occur, including:

• Injuries to nerves and blood vessels
• Intra-articular damage
• Delayed union of bone grafts
• Heterotopic ossification, which is the formation of bone in soft tissues where it normally doesn't exist

The primary goal of the procedure is to preserve natural bone and provide a well-functioning hip joint at a young age to prevent the need for a hip replacement later in life.