The natural history of hip dislocations in ambulatory myelomeningoceles

We studied 22 myelomeningocele patients with strong quadriceps and good ambulatory capability who had a dislocated hip. These patients did not have hip pain, had good to excellent hip motion and could sit with no difficulty. All but one was a good to excellent community ambulator with crutches and orthoses. Twenty-five percent had limb length inequality requiring shoe lifts but this combination did not impair functional capability. None owned wheelchairs. Seven had associated musculo-skeletal deformities which required treatment. We concluded that the hip dislocation in these patients was not significant. We evaluated a similar series of 11 patients who had open reduction of a dislocated hip an average of 18 months ago. Two patients were slightly improved and five patients were significantly worse after the open reductions. Serious complications related to the surgery ensued in half of the cases. The cost of the surgery and treatment of the complications in these 11 patients was $400,000. We concluded that surgical treatment of paralytic hip dislocations in ambulatory myelomeningocele patients offered no clear cut benefit.