Hip dislocation in children with myelomeningocele may either be teratological or paralytic. Paralytic dislocation of the hip occurs because of paralysis of the hip abductors and extensors w/ unopposed pull of the hip flexors and adductors. Surgical reduction of hips in patients with spina bifida is associated with a high failure rate and therefore treatment indications are controversial. In general, reduction for patients with L4 level is most controversial and may be considered if unilateral. Dislocated hips in patients with L3 level and above are typically left alone. These indications may vary from center to center.
Gabrieli et al evaluated 20 patients, divided into two groups, with a diagnosis of low lumbar myelomeningocele using 3D gait analysis. All patients were community ambulators with a unilateral hip dislocation and no scoliosis. Gait symmetry corresponded to the absence of hip contractures or bilateral symmetrical hip contractures, and had no relation to the presence of hip dislocation. The authors concluded that in patients with a symmetric gait, reduction of the hip is unnecessary.
Herring JA, ed. Tachdjian's Pediatric Orthopaedics. 4th ed. Philadelphia, PA: WB Saunders; 2008:1431-1435.
Gabrieli AP, Vankoski SJ, Dias LS, Milani C, Lourenco A, Filho JL, Novak R. Gait analysis in low lumbar myelomeningocele patients with unilateral hip dislocation or subluxation. J Pediatr Orthop. 2003 May-Jun;23(3):330-4.
PMID:12724595 (Link to Abstract)