Pemberton Osteotomy for Acetabular Dysplasia.

INTRODUCTION: We have performed open reduction with Pemberton osteotomy, as our primary treatment method for developmental dysplasia of the hip, in more than 550 patients at our institution since 1993. STEP 1 EXPOSURE: With the patient supine, make an anterior iliofemoral incision that is not directly on the iliac crest, dissect the subcutaneous tissue in the line of the incision, expose the iliac crest, and divide the cartilage at the iliac crest. STEP 2 PERFORM ILIOPSOAS TENOTOMY: Identify the rectus femoris tendon, release the iliopsoas muscle, and identify the acetabulum-hip capsule junction. STEP 3 PERFORM OPEN REDUCTION AND OSTEOTOMY: Perform an open reduction, check hip stability, make medial and lateral cut lines, and complete the osteotomy. STEP 4 INSERT ILIAC BONE GRAFT: Harvest the graft, position the reduced hip joint, insert the bone graft, repair the capsule, and close the wound. STEP 5 POSTOPERATIVE MANAGEMENT: Apply a hip spica cast after skin closure. RESULTS & PREOP/POSTOP IMAGES: In our clinical and radiographic review of forty-nine patients followed for more than ten years after treatment of developmental dysplasia of the hip with a unilateral Pemberton osteotomy, there were no redislocations and no patient required additional surgery for residual hip dysplasia after the original Pemberton osteotomy. WHAT TO WATCH FOR: Indications Contraindications Pitfalls & Challenges.