Articulation coxo-fémorale et grossesse

Abstract

One third of pregnant women can complain of the hip, but other sources of pain must first be ruled out: spine, sacroiliac, pubis, pelvis, trochanter, and tendons (including gluteus minus). Entrapment of lateral cutaneous and obturator nerves should not be forgotten. Once a coxo-femoral origin is ascertained, the most frequent diagnosis might be labral stresses or tears, although a high percentage of false negative on imaging often preclude a firm diagnosis. Septic arthritis are very rare but unusual bacteria like streptococcus B can be noticed. MRI must be requested each time hip pain or limping is lasting enough, first to seek for stress fractures with or without underlying osteopenia, since they can progress to displaced fractures or osteonecrosis leading to hip prosthesis following delivery. Several mechanisms could co-exist to account for the underlying hip osteopenia: 1-pregnancy-related transient osteoporosis (which mainly induces multiple vertebral fractures); 2-algodystrophy (more often unilateral as compared to other explanations of hip osteopenia); oedema of the femoral neck and/or epiphysis, or full-blown osteonecrosis, possibly fostered by venous stasis secondary to compression by the foetus of maternal large veins in the pelvis. Previous hip prostheses have no influence on pregnancy outcome, and later children health, although abnormal levels of cobalt and chromium are usually found in their cord blood.