The Hip in Myelomeningocele

Abstract

Musculoskeletal manifestations associated with myelomeningocele (MMC) are common; often resulting in significant functional impairments relating to gait abnormalities, seating imbalance, and skin ulceration. Hip deformities, including soft tissue contractures and dislocation, are seen across neurosegmental levels; the former of which may cause impairments in ambulatory capacity. Hip dislocation in MMC was treated aggressively in the past due to a then commonly held view that reducing these hips would lead to better outcomes. Over the last 20 years, this view has been challenged, with best evidence suggesting that the risks of treatment for hip dislocation in spina bifida far outweigh the benefits. Muscle lengthening, however, can lead to improvements in gait and function. This chapter will review the evidence relating to the treatment of the hip in spina bifida, emphasizing a measured approach when addressing associated deformities, particularly with respect to dislocation.