Page 33 - Delaware Medical Journal - March/April 2019

CASE REPORT
follow-up term (mean of 4.4 years) cannot be considered long enough to detect recurrence. One patient with hypotonia (not included in the study) had a bilateral hip reconstruction at our institution 30 years ago; he had bilateral revision surgery for recurrent subluxation more than four years after the index surgery. At an incidental contact with him 10 years later, he still had bilateral hip pain and further surgery was planned for him.
In addition to the retrospective nature, limitations of this study included the small number of patients, the variability of diagnoses, the inability to standardize radiographs, and the heterogeneity of our group of patients. This is due to the rarity of the conditions and the inability to reach a diagnosis in many cases. The follow-up term was short (mean of four years); however, this study provides a preliminary report about the hypotonic hip in an underreported group of children. Our plan is to follow this group to detect any potential risk factors for hip subluxation and eventually prevent its progress.
This study suggests that hip subluxation with MP > 50% is not common in the context of congenital central hypotonia. However, some children develop hip subluxation without pain or movement (abduction) limitation. Therefore, radiographic hip evaluation is essential in making the diagnosis. Even with early normal screening (<5 years of
age) the risk of subluxation remains. Consistent radiographic follow-up is recommended with longer intervals than in spastic hips (every 2-4 years) since displacement in most hypotonic hips tends not to progress.
CONTRIBUTING AUTHORS
■ OUSSAMA ABOUSAMRA, MD is a former research fellow at Nemours/Alfred I. duPont Hospital for Children in Wilmington. He is currently a clinical fellow at Nationwide Children’s Hospital in Columbus, Ohio.
■ MARIA DEL PILAR DUQUE OROZCO, MD is a former research fellow at Nemours/Alfred I. duPont Hospital for Children. She is currently a pediatric orthopaedic surgeon in Medellin, Colombia.
■ MEHMET SERHAN ER, MD is a former research fellow at Nemours/Alfred I. duPont Hospital for Children. He is currently a practicing pediatric orthopaedic surgeon in Turkey.
■ KENNETH J. ROGERS, PHD, ATC is the Program Manager for Clinical Research with the Department of Orthopaedics at Nemours/Alfred I. duPont Hospital for Children. He has published
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■ JULIEANNE P. SEES, DO is a pediatric orthopaedic surgeon at Nemours/Alfred I. duPont Hospital for Children. Her sub-specialty is cerebral palsy.
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