Chiari Pelvic Osteotomy and Femoral Varus Osteotomy for Recurrent Hip Dislocation in a Patient With Complete Lower Extremity Paralysis Due to Spina Bifida at the Thoracic Level.

Abstract

Spina bifida can result in lower-extremity motor and sensory deficits, often leading to hip joint dislocation, a significant disability. The optimal surgical approach for hip dislocation in spina bifida patients remains a subject of debate. A 12-year-old girl with thoracic-level spina bifida experienced recurrent hip dislocations, significantly impacting her daily life and sports activities. At the age of 13, she underwent a femoral varus osteotomy. However, after six months, her hip dislocated again. At the age of 14, she underwent a Chiari pelvic osteotomy in addition. Six years later, she exhibited no limitations in her daily activities and sports participation. We report the first successful treatment of recurrent hip dislocation in a spina bifida patient with thoracic-level involvement, utilizing a combination of femoral varus osteotomy and pelvic osteotomy. Prior to surgical intervention, not only a comprehensive assessment of the patient's physical examination but also an assessment of their goals and living environment are essential.