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American Journal of Physical Medicine & Rehabilitation:
doi: 10.1097/PHM.0b013e3182466521
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Unreduced Congenital Dislocation of Both Hips in an Adult Woman

Cordero-García, Carlos MD; Nieto-Castilla, Andrés MD; López-Ferrán, Emilio MD; Amores-García, Isabel MD, PhD

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From the Departments of Physical Medicine and Rehabilitation (CC-G, AN-C, IA-G), and Radiology, Juan Ramón Jiménez Hospital, Huelva, Spain (EL-F).

All correspondence and requests for reprints should be addressed to: Carlos Cordero-García, MD, Department of Physical Medicine and Rehabilitation, Juan Ramón Jiménez Hospital, Ronda Norte s/n, 21005 Huelva, Spain.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

A 60-yr-old woman was referred because of an abnormally painful gait. The clinical examination revealed tenderness in both hips with a positive Trendelenburg sign. There was no family history of interest. Radiologic examination showed bilateral hip dislocation and a leg length discrepancy of less than 1 cm in the lower limbs. A 64-multislice computed tomographic scan indicated a developmental abnormality of both acetabular cavities with ventrolateral dislocation of the femoral heads (Fig. 1). Neoarticulation was seen in both iliac blades as well as severe secondary osteoarthritis (Fig. 2). The defect caused coxa vara with proximal femoral anteversion, valgus deformity, and greater trochanter displacement. These findings were consistent with congenital hip dysplasia in an adult woman. The patient did improve, showing a significant decrease in hip pain after 30 sessions of physical therapy.

Figure 1
Figure 1
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Figure 2
Figure 2
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The natural outcome of unreduced congenital hip dislocation has not been frequently described in the scientific literature. There are some references as to the functional level of these patients. Wedge and Wasylenko1 reported that 59% of patients with unreduced congenital hip dislocation had a fair or poor prognosis, although some of the older patients showed acceptable function and little discomfort. Moreover, Hasegawa and Iwata2 reported that walking ability was reduced in patients with unreduced congenital hip dislocation and that walking aids were needed in about two thirds of patients. They also reported that patients older than 50 years significantly experienced lower back pain, buttock pain, and knee pain.2 Surgical treatment of unreduced congenital hip dislocation is considered controversial.3

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REFERENCES

1. Wedge JH, Wasylenko MJ: The natural history of congenital disease of the hip. J Bone Joint Surg 1979; 61: 334–8

2. Hasegawa Y, Iwata H: Natural history of unreduced congenital dislocation of the hip in adults. Arch Orthop Trauma Surg 2000; 120: 17–22

3. Hartofilakidis G, Stamos K, Karachalios T: Treatment of high dislocation of the hip in adults with total arthroplasty. Operative technique and long-term clinical results. J Bone Joint Surg 1998; 80: 510–7

© 2012 Lippincott Williams & Wilkins, Inc.

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