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Published on: March 23, 2019
Gait analysis in low lumbar myelomeningocele patients with unilateral hip dislocation or subluxation
Ana Paula T Gabrieli1, Stephen J Vankoski, Luciano S Dias
1Children's Memorial Hospital/Northwestern University Medical School, 680 North Lake Shore Drive, Chicago, IL 60611, USA.
Insights
Surgical hip reduction is unnecessary for patients with low lumbar myelomeningocele (LMM) and unilateral hip dislocation. Gait symmetry in LMM patients depends on hip contractures, not dislocation itself.
Area of Science:
- Orthopedics
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Unilateral hip dislocations/subluxations in low lumbar myelomeningocele (LMM) present complex treatment challenges.
- Surgical indications for hip instability in LMM patients remain debated, impacting mobility and function.
Purpose of the Study:
- To investigate the impact of unilateral hip dislocation/subluxation on gait symmetry in LMM patients.
- To determine the relationship between hip contractures and gait patterns in this population.
Main Methods:
- Three-dimensional gait analysis was performed on 20 community-ambulating LMM patients using orthoses and crutches.
- Patients were categorized into two groups based on the presence/absence or symmetry of hip flexion/adduction contractures.
- Pelvic and hip kinematics were assessed to evaluate gait symmetry.
Main Results:
- Seven of 10 patients without significant hip contractures exhibited symmetric gait.
- Only 2 of 10 patients with unilateral hip contractures demonstrated symmetric gait.
- Gait symmetry correlated with the absence or bilateral symmetry of hip contractures, independent of hip dislocation status.
Conclusions:
- Hip contractures, rather than hip dislocation, are the primary determinant of gait asymmetry in LMM patients.
- Hip reduction surgery may not be necessary for improving gait symmetry in this patient cohort.
Abstract:
The surgical indications for the treatment of unilateral hip dislocations or subluxations in patients with low lumbar myelomeningocele remain highly debatable. This study examines the influence of unilateral hip dislocation or subluxation on the gait of these patients using three-dimensional gait analysis. Twenty patients with a diagnosis of low lumbar myelomeningocele underwent three-dimensional gait analysis. All patients were community ambulators with solid ankle-foot orthoses and crutches who presented with unilateral hip dislocation or subluxation and no scoliosis. The patients were divided in two groups. Group 1 comprised 10 patients who demonstrated either no evidence of hip flexion or adduction contractures or symmetric hip contractures. Group 2 comprised 10 patients with unilateral hip flexion and/or adduction contractures. Pelvic and hip kinematics were assessed to determine the symmetry of motion between the involved and the noninvolved side during walking. Seven patients from group 1 walked with a symmetric gait pattern; only two patients from group 2 walked with a symmetric pattern. 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 reduction of the hip is unnecessary.
