Abstract
Arthrogryposis represents a group of heterogeneous disorders, characterized by contractures of multiple joints at birth. Involvement of the hip is very common (55–90% of patients) ranging from soft tissue contractures to subluxation and dislocation. Isolated contracture of the hip can usually be managed conservatively: compensative mechanisms and contractures of other joints should be evaluated before planning surgery. For unilateral dislocations, open reduction is indicated to provide a level pelvis, even though the risk of stiffness, avascular necrosis and redislocation is significant. Indications for surgical reduction of bilateral dislocations are more controversial: an adequate evaluation of ambulatory potential of the child (muscular weakness, involvement of upper extremities, etc.) and of stiffness of the hips is suggested. An extensive and long-lasting programme of bracing, physiotherapy and multiple surgery may lead to some measure of functional ambulation in most cases, but high need for surgery and considerable risk of complications must be considered. This paper summarizes problems and principles of treatment for hip contractures and dislocations in arthrogryposis and provides a review of the current literature.
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References
Bernstein RM (2002) Arthrogryposis and amyoplasia. J Am Acad Orthop Surg 10(6):417–424
Bamshad M, Van Heest AE, Pleasure D (2009) Arthrogryposis: a review and update. J Bone Joint Surg Am 91(Suppl 4):40–46
Hall JG (1997) Arthrogryposis multiplex congenita: etiology, genetics, classification, diagnostic approach, and general aspects. J Pediatr Orthop B 6(3):159–166
Bevan WP, Hall JG, Bamshad M, Staheli LT, Jaffe KM, Song K (2007) Arthrogryposis multiplex congenita (amyoplasia): an orthopaedic perspective. J Pediatr Orthop 27(5):594–600
Hall JG (1985) Genetic aspects of arthrogryposis. Clin Orthop Relat Res 194:44–53
Swinyard CA, Bleck EE (1985) The etiology of arthrogryposis (multiple congenital contracture). Clin Orthop Relat Res 194:15–29
Florio L (1976) Multiple congenital arthrogryposis. Arch Putti Chir Organi Mov 27:255–410
Sells JM, Jaffe KM, Hall JG (1996) Amyoplasia, the most common type of arthrogryposis: the potential for good outcome. Pediatrics 97(2):225–231
Beals RK (2005) The distal arthrogryposes: a new classification of peripheral contractures. Clin Orthop Relat Res 435:203–210
Carlson WO, Speck GJ, Vicari V, Wenger DR (1985) Arthrogryposis multiplex congenita. A long-term follow-up study. Clin Orthop Relat Res 194:115–123
St Clair HS, Zimbler S (1985) A plan of management and treatment results in the arthrogrypotic hip. Clin Orthop Relat Res 194:74–80
Huurman WW, Jacobsen ST (1985) The hip in arthrogryposis multiplex congenita. Clin Orthop Relat Res 194:81–86
Fassier A, Wicart P, Dubousset J, Seringe R (2009) Arthrogryposis multiplex congenita. Long-term follow-up from birth until skeletal maturity. J Child Orthop 3(5):383–390
Ferrari D, Bettuzzi C, Donzelli O (2008) Freeman-Sheldon syndrome. A case report and review of the literature. Chir Organi Mov 92(2):127–131
Savini R, Gualdrini G (1980) Report on two cases of Freeman-Sheldon syndrome (“whistling face”). Ital J Orthop Traumatol 6(1):105–115
Leonard M, Nicholson P (2010) Total hip arthroplasty in a patient with arthrogryposis and an ipsilateral above knee amputation. Hip Int 20(4):559–561
Kroksmark AK, Kimber E, Jerre R, Beckung E, Tulinius M (2006) Muscle involvement and motor function in amyoplasia. Am J Med Genet A 140(16):1757–1767
Hoffer MM, Swank S, Eastman F, Clark D, Teitge R (1983) Ambulation in severe arthrogryposis. J Pediatr Orthop 3(3):293–296
Canavese F, Sussman MD (2009) Strategies of hip management in neuromuscular disorders: Duchenne Muscular Dystrophy, Spinal Muscular Atrophy, Charcot-Marie-Tooth Disease and Arthrogryposis Multiplex Congenita. Hip Int 19(Suppl 6):S46–S52
Lloyd-Roberts GC, Lettin AWF (1970) Arthrogryposis multiplex congenita. J Bone Joint Surg Br 52-B:494–508
Milgram JW, Tachdjian MO (1976) Pathology of the limbus in untreated teratologic congenital dislocation of the hip. A case report of a ten-month-old-infant. Clin Orthop Relat Res 119:107–111
Akazawa H, Oda K, Mitani S, Yoshitaka T, Asaumi K, Inoue H (1998) Surgical management of hip dislocation in children with arthrogryposis multiplex congenita. J Bone Joint Surg Br 80(4):636–640
Yau PW, Chow W, Li YH, Leong JC (2002) Twenty-year follow-up of hip problems in arthrogryposis multiplex congenita. J Pediatr Orthop 22(3):359–363
Szöke G, Staheli LT, Jaffe K, Hall JG (1996) Medial-approach open reduction of hip dislocation in amyoplasia-type arthrogryposis. J Pediatr Orthop 16(1):127–130
Gruel CR, Birch JG, Roach JW, Herring JA (1986) Teratologic dislocation of the hip. J Pediatr Orthop 6(6):693–702
Staheli LT, Chew DE, Elliott JS, Mosca VS (1987) Management of hip dislocations in children with arthrogryposis. J Pediatr Orthop 7(6):681–685
Asif S, Umer M, Beg R, Umar M (2004) Operative treatment of bilateral hip dislocation in children with arthrogryposis multiplex congenita. J Orthop Surg (Hong Kong) 12(1):4–9
Shapiro F, Specht L (1993) The diagnosis and orthopaedic treatment of childhood spinal muscular atrophy, peripheral neuropathy, Friedreich ataxia, and arthrogryposis. J Bone Joint Surg Am 75(11):1699–1714
Eriksson M, Gutierrez-Farewik EM, Broström E, Bartonek A (2010) Gait in children with arthrogryposis multiplex congenita. J Child Orthop 4(1):21–31
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Stilli, S., Antonioli, D., Lampasi, M. et al. Management of hip contractures and dislocations in arthrogryposis. Musculoskelet Surg 96, 17–21 (2012). https://doi.org/10.1007/s12306-012-0180-9
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DOI: https://doi.org/10.1007/s12306-012-0180-9