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observation.
42%
301/714
bilateral adductor and iliopsoas releases, with nighttime abduction bracing.
9%
63/714
proximal femoral varus osteotomy with internal fixation.
11%
78/714
proximal femoral varus osteotomy with volume-reducing periacetabular osteotomy.
18%
127/714
proximal femoral varus osteotomy with shelf acetabular augmentation.
19%
136/714
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Observation is the treatment of choice. Hip subluxation and dislocation are not uncommon in patients with SMA type II who are unlikely to be ambulatory. Scoliosis occurs in these patients 100% of the time and frequently creates pelvic obliquity. However, in long-term follow-up, patients with SMA type II and hip dislocations had little associated pain or functional limitations because of hip instability. In addition, recurrent hip subluxation after surgical treatment has been documented. Given the rarity of symptoms from hip instability in long-term follow-up, and the possibility of recurrent dislocation, surgical intervention for hip instability may expose SMA type II patients to undue surgical risk for minimal if any functional gain.
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