The effect of hip reduction on function in patients with myelomeningocele. Potential gains and hazards of surgical treatment.
We studied seventy-six patients with myelomeningocele who were more than five years old and ahd had no hip surgery during the two previous years. Of these seventy-six patients, forty-one had had no operative treatment intended to reduce the dislocation of their hips and thirty-five had been operated on one or more times to reduce or maintain reduction of one or both hips. The presence of the femoral head in the acetabulum did not improve range of hip motion or ability to walk, nor did it reduce the amount of bracing required or decrease pain. The complications of surgical treatment to gain reduction were numerous and included failure to obtain stability in 40 per cent of the hips, loss of hip motion, and fractures. A level pelvis and a good range of hip motion were found to be more important for function than reduction of the hips. The goal of treatment should be maximum function, not roentgenographic reduction of the dislocated hip.
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001915:Braces; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005684:Gait; D006617:Hip Dislocation / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008124:Locomotion; D008297:Male; D008591:Meningomyelocele / Q000150:complications / Q000534:rehabilitation*; D010146:Pain; D010243:Paralysis / Q000150:complications*