Progress in the management of the paralytic hip in myelomeningocele

1. The primary aim of management at the hip joint in the patient with myelomeningocele is the prevention and correction of deformity, usually a flexion deformity. 2. It is necessary to treat both flexion deformity and the causative muscle imbalance; correction of this imbalance will also prevent subsequent dislocation of the lip. 3. The psoas tendon is generally excised; transfer is reserved for a few children with excellent walking potential and a good prognosis from all viewpoints. 4. Flexion deformity is treated by a soft tissue release procedure (for children under the age of eight years and for deformities of less than 45 degrees) or extension osteotomy. 5. Hip dislocation is seldom treated if it is bilateral. Whether to treat dislocation depends also on the potential of the child and the degree of dislocation.