title: Management of hip contractures and dislocations in arthrogryposis.
abstract: Arthrogryposis represents a group of heterogeneous disorders, characterized by contractures of multiple joints at birth. Involvement of the hip is very common (55-90% of patients) ranging from soft tissue contractures to subluxation and dislocation. Isolated contracture of the hip can usually be managed conservatively: compensative mechanisms and contractures of other joints should be evaluated before planning surgery. For unilateral dislocations, open reduction is indicated to provide a level pelvis, even though the risk of stiffness, avascular necrosis and redislocation is significant. Indications for surgical reduction of bilateral dislocations are more controversial: an adequate evaluation of ambulatory potential of the child (muscular weakness, involvement of upper extremities, etc.) and of stiffness of the hips is suggested. An extensive and long-lasting programme of bracing, physiotherapy and multiple surgery may lead to some measure of functional ambulation in most cases, but high need for surgery and considerable risk of complications must be considered. This paper summarizes problems and principles of treatment for hip contractures and dislocations in arthrogryposis and provides a review of the current literature.
authors.affiliation: Department of Paediatric Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, via Pupilli 1, 40136, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Stilli
authors.forename: Diego
authors.initials: D
authors.lastname: Antonioli
authors.forename: Manuele
authors.initials: M
authors.lastname: Lampasi
authors.forename: Onofrio
authors.initials: O
authors.lastname: Donzelli
mesh_terms: D001176:Arthrogryposis / Q000150:complications*; D001915:Braces; D003025:Clubfoot / Q000601:surgery; D005271:Femur Head Necrosis / Q000209:etiology; D006616:Hip Contracture / Q000151:congenital / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006618:Hip Dislocation, Congenital / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D026741:Physical Therapy Modalities; D016896:Treatment Outcome