Paralytic dislocation of the hip in myelodysplasia. The role of the adductor transfer.
In thirty-nine patients with myelodysplasia at the third, fourth, or fifth lumbar level and subluxation or dislocation of the hip (fifty-nine hips involved), the following surgical approaches were utilized to balance the muscles about the hip: In one group (twenty hips in eleven patients) the origins of the adductors longus, brevis, and gracilis were transferred to the ischial tuberosity, and in fifteen hips in that group the iliopsoas also was transferred to the greater trochanter when the abductors were severely weakened. In the second group (thirty-nine hips in twenty-eight patients), only the iliopsoas transfer was done. Group I patients demonstrated improved muscle balance with less severe flexion-adduction contractures; increased power in abduction and extension; and a higher incidence of stable hips at follow-up.