title: Idiopathic hypertonicity as a cause of stiffness after surgery for developmental dysplasia of the hip.
abstract: BACKGROUND
  There are various complications reported with surgical treatment of DDH. Most studied complication is avascular necrosis of the femoral head and hip stiffness. The purpose of this report was to describe a case with severe stiffness of the hip due to hypertonicity in periarticular muscles after it was treated for developmental dysplasia of the hip (DDH).
  
  
  METHODS
  Three-year-old patient referred to our institution with bilateral DDH. Two hips were operated separately in one year with anterior open reduction, femoral shortening osteotomy. Third month after last surgery, limited right hip range of motion and limb length discrepency identified. Clinical examination revealed that patient had limited range of motion (ROM) in the right hip and compensated this with pelvis obliquity. Gluteus medius, sartorius and iliofemoral band release performed after examination under general anesthesia. Symptoms were persisted at 3rd week control and examination of the patient in general anesthesia revealed full ROM without increased tension. For the identified hypertonicity, ultrasound guided 100IU botulinum toxin A injection performed to abductor group and iliopsoas muscles. Fifth month later, no flexor or abductor tension observed, and there was no pelvic obliquity.
  
  
  CONCLUSIONS
  Stiffness as a complication is rare and is usually resolved without treatment or simple physical therapy. Usually it is related with immobilization or surgery associated joint contracture, and spontaneous recovery reported. Presented case is diagnosed as hip stiffness due to underlying local hypertonicity. That is resolved with anesthesia and it was treated after using botulinum toxin A injection.
  
  
  CONCLUSIONS
  Hypertonicity with hip stiffness after surgical treatment of DDH differ from spontaneous recovering hip range of motion limitation and treatment can only be achieved by reduction of the muscle hypertonicity by neuromuscular junction blockage.
authors.affiliation: İstanbul University, İstanbul Medicine Faculty, Orthopaedics and Traumatology Department, Millet caddesi. Çapa, Fatih, İstanbul, Turkey. Electronic address: doktorturgut@yahoo.com.
authors.forename: Turgut
authors.initials: T
authors.lastname: Akgül
authors.affiliation: İstanbul University, İstanbul Medicine Faculty, Orthopaedics and Traumatology Department, Millet caddesi. Çapa, Fatih, İstanbul, Turkey. Electronic address: sbgoksan@istanbul.edu.tr.
authors.forename: Süleyman Bora
authors.initials: SB
authors.lastname: Göksan
authors.affiliation: İstanbul University, İstanbul Medicine Faculty, Orthopaedics and Traumatology Department, Millet caddesi. Çapa, Fatih, İstanbul, Turkey. Electronic address: Ilker.eren@gmail.com.
authors.forename: Ilker
authors.initials: I
authors.lastname: Eren
keywords: Hip dysplasia; Hip stiffness; Idiopathic hypertonicity