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Dislocation of hip in myelomeningocele. The McKay hip stabilization
Insights
The McKay procedure, a surgical intervention for unstable hips in children with myelomeningocele, demonstrated success in maintaining hip stability for many patients. This study highlights the importance of individualized treatment based on documented hip instability.
Area of Science:
- Pediatric Orthopedics
- Spinal Cord Injury Research
- Biomechanical Engineering
Background:
- Myelomeningocele often leads to hip instability in children.
- Previous surgical interventions have shown variable success rates.
- The McKay procedure involves varus osteotomy and muscle transfer for hip stabilization.
Purpose of the Study:
- To evaluate the clinical and radiographic outcomes of the McKay procedure in children with myelomeningocele-related hip instability.
- To assess the procedure's effectiveness in different hip conditions (e.g., subluxated, dislocated, at risk).
- To refine the indications for the McKay procedure based on neurological status and hip stability.
Main Methods:
- Retrospective review of 66 hips in 34 children undergoing the McKay procedure.
- Average follow-up of 10.9 years.
- Analysis of outcomes based on neurological stability and hip condition.
Main Results:
- The McKay procedure maintained stability in 37 of 51 hips in neurologically stable children.
- Success rates varied by hip condition, with higher success in subluxated hips (15/16) and hips at risk (17/19).
- In neurologically deteriorating patients, 8 of 15 hips showed success, with varying results based on hip condition.
Conclusions:
- The McKay procedure is a viable option for improving hip stability in select children with myelomeningocele.
- Careful patient selection, considering documented hip instability and neurological status, is crucial for optimal outcomes.
- The indication for the procedure has evolved to target hips with documented instability, rather than all myelomeningocele patients at specific lumbar levels.
Abstract:
We reviewed the clinical and radiographic results of varus osteotomy of the proximal aspect of the femur and transfer of the adductor and external oblique muscles (the McKay procedure) in thirty-four children (sixty-six hips) who had an unstable hip secondary to a myelomeningocele at the middle or caudad lumbar level. the average age at the time of the operation was twenty months (range, seven to forty-two months). The average duration of follow-up was 10.9 years (range, 0.7 to 20.0 years). An open reduction was performed in ten hips. None of the children had had any previous operative treatment. The index operation helped to maintain the stability of thirty-seven of the fifty-one hips twenty-six children who remained neurologically stable: seventeen of nineteen hips that were at risk, two of three hips with acetabular dysplasia, fifteen of sixteen subluxated hips, one of three dislocated hips that had been previously reduced with a Pavlik harness, one of two dislocatable hips, and one of seven previously untreated dislocated hips. The index operation was not successful for one dislocated hip that had been treated with closed reduction and application of a spica cast. The operation was a success for eight of the fifteen hips in eight children who had a progressive loss of neurological function: three of five hips that were at risk, one hip with acetabular dysplasia, two of four subluxated hips, one of two that had been previously reduced with a Pavlik harness, and one dislocatable hip. Two dislocated hips redislocated. Initially the index operation was performed on all children who had a myelomeningocele at the third or fourth lumbar level. Recent data have shown that the hips in these children are not all at risk, and we now perform the operation only if there is documented instability of the hip.