Pemberton Osteotomy (Anterolateral Acetabuloplasty)
The Pemberton osteotomy was originally described by Pemberton in 1965 as the pericapsular pelvic osteotomy. It is widely recommended for the treatment of acetabular dysplasia, and combined procedure in reduction of hip subluxation, or frank hip dislocation in children. Pemberton acetabuloplasty is characterized by a reshaping of the acetabular roof with hinging on the triradiate cartilage after an incomplete iliac osteotomy. The shape of the acetabulum is modified by rotating the acetabular fragment caudally and anteriorly to improve the anterior and lateral coverage of the femoral head. Two similar modifications of the Pemberton osteotomy, the Dega osteotomy and the San Diego osteotomy, were designed for similar purposes. Most experienced pediatric orthopedic surgeons can expect the Pemberton acetabuloplasty to yield greater correction of acetabular dysplasia than the Salter innominate osteotomy, without the need of internal fixation for the osteotomy site. The iatrogenic injury to the triradiate cartilage resulting from an incorrectly performed Pemberton osteotomy is a possible serious complication, which may cause premature closure of the triradiate cartilage with a resultant shallow acetabulum. In our previous study, children with developmental dysplasia of the hip who had excessive downward depression of the distal fragment following osteotomy had a higher risk of developing femoral head osteonecrosis because of over reduction of the femoral head.
The Pemberton pericapsular osteotomy has been an effective standard option in our institution in over 20 years for treatment of developmental dysplasia of the hip. This chapter is to demonstrate step-by-step detail of the procedure.