Current experience in the treatment of neurogenic deformities of the hip joint in patients with myelomeningocoele.

BACKGROUND: The purpose of this study is to present the current approach to and an evaluation of the results of treatment of neurogenic deformities of the hip joints in children with myelomeningocoele (MMC). MATERIAL AND METHODS: The study population consisted of 210 patients with MMC admitted to the Department of Pediatric Orthopaedics and Traumatology in Poznan in the years 1970-2008. The study involved 131 hips (85 patients). The duration of follow-up was 1 to 38 years (mean 17.3 years). The clinical status of patients and treatment results were evaluated with regard to the assignment of the patient to one of 6 groups according to the modified Sharrard and Parsch classification. Radiographic evaluation included the femoral neck angle, anteversion angle, acetabular index, head-acetabular coefficient, centre-edge angle, focusing angle, and Labaziewicz distance angle. The operative treatment in Groups I-II consisted of correction of contractures. In Group III, we performed open reduction of the dislocation or subluxation, Mustard iliopsoas transfer, intertrochanteric femoral osteotomy and Dega's transiliac osteotomy, or shelf procedure. In Group IV patients, we corrected subluxations or dislocations. RESULTS: Surgery in patients from Groups I-II was associated with a high rate of recurrence. In Group III patients, we achieved good joint stability. The transferred iliopsoas muscle was active in 70% of the patients and 65% of the patients in this group became ambulant. More beneficial functional effects were observed after operative treatment in patients from Group IV. CONCLUSIONS: In Groups I-II recurrence of the deformity was often observed. In patients from Groups III-IV, good functional outcomes were noted after comprehensive surgical treatment.