Pemberton’s acetabuloplasty without cast application for the treatment of acetabular dysplasia in older children: A case series

Objectives: To study the safety and efficacy of performing Pemberton’s acetabuloplasty (PA) in older children without application of post-operative cast to avoid the restriction and complications of cast in older children. Methods: Patients who had acetabular dysplasia and underwent Pemberton’s acetabuloplasty without cast during the period 1999-2021 were selected for the study. Cases were followed until radiographic healing of the osteotomy. Results: Twenty patients (22 hips) were included in the study. Primary acetabular dysplasia was recently discovered because of pain in 10 patients; the other 10 had residual acetabular dysplasia after treatment of developmental hip dysplasia (DDH). Most patients (19 hips in 18 patients) had a PA without internal fixation and post-operative cast. Two patients had an internal fixation with a cannulated screw because of concern about compliance with non/toe-touch weight-bearing post-operatively. The mean age on the time of surgery was 10.4 years (6.5–15.5 years). The mean body weight on the day of surgery was 42.8 Kg. (30-66 Kg.). The mean postoperative follow-up was 38 months (three months – 14 years). All patients were able to walk using a walker within five days after surgery. The follow-up radiographs showed no graft collapse and no displacement of the graft or osteotomy. Correction of the acetabular dysplasia and corrected Shenton’s line were confirmed on the last follow-up with no re-dislocation or re-subluxation of the hip. Conclusion: Performing Pemberton’s acetabuloplsty in older children without application of post-opertaive cast is efficient and safe. Complications of cast and the gross limitation it has on daily living activities and mobilization are all avoided without compromising the surgical results and healing. Care should be taken to ensure that patients and caregivers clearly understand the importance of non/toe-touch weight-bearing post-operatively and are compliant.