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Occult spinal dysraphism in established congenital dislocation of the hip
1Southampton General Hospital, Shirley, England.
Insights
Congenital hip dislocation treatment failures in infants were linked to genetic, iatrogenic, and neurological factors. Many cases showed subtle spinal dysraphism signs and developed leg rotation, indicating underlying neurological deficits.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Developmental Pediatrics
Background:
- Established dislocations of the hip in infants present a significant orthopedic challenge.
- Primary surgical treatment aims for stable reduction and acetabular remodeling.
- Treatment failures necessitate understanding underlying contributing factors.
Purpose of the Study:
- To investigate the factors contributing to treatment failures in established hip dislocations in one-year-old infants.
- To identify clinical and radiological indicators of poor surgical outcomes.
- To explore potential neurological associations with treatment resistance.
Main Methods:
- Retrospective analysis of 117 infants (130 hips) with established dislocations treated surgically.
- Clinical examination for physical stigmata and assessment of leg posture.
- Radiographic evaluation of femoral head position and acetabular congruency.
- Sensory spinal evoked potential (SSEP) testing to assess neurological function.
Main Results:
- 11% of infants failed to achieve stable reduction after primary surgery.
- Genetic and iatrogenic factors explained half of the treatment failures.
- A significant proportion of treatment failures exhibited lateral leg rotation and smaller foot size.
- Radiological findings included lateral femoral head drift and persistent subluxation.
- SSEP testing revealed neurological deficits in the majority of infants with treatment failures, despite no clear clinical denervation.
Conclusions:
- Treatment failures in infantile hip dislocations are multifactorial, with genetic, iatrogenic, and occult neurological deficits playing key roles.
- Subtle signs like leg rotation and foot size discrepancy may indicate underlying neurological issues impacting surgical success.
- Further investigation into neurological deficits is warranted in cases of persistent hip subluxation after surgery.
Abstract:
Of a consecutive series of 117 one-year-old infants with 130 established dislocations of the hip, 11% failed to respond to primary surgical treatment. Genetic and iatrogenic factors accounted for half the failures. There were no obvious causes in the remainder, though a few had the superficial stigmata of spinal dysraphism, and by two years of age, most of the group had developed a lateral rotation posture of the affected leg associated with a relatively smaller foot on that side. Radiologically, the femoral head had drifted and rotated laterally out of the surgically deepened acetabulum, causing persistent subluxation. Although there was no clinical evidence of sensory or motor denervation, sensory spinal evoked potential tests revealed the presence of neurological deficits in the majority of patients in this group.