Congenital hip contracture

Objective To review the management of congenital abduction contraction of the hip in children. Methods Two hundred and sixteen children with abduction contraction of the hip were managed in our hospital between 1982 and 2000. Of these, 15 were congenital contractures. The average age of the 15 children at presentation was {6.1} years (3-12 years). There were 9 boys and 6 girls. There were 11 bilateral and 4 unilateral contractures. The common signs included inability to squat with the knees touching each other, inability to cross the legs sitting and pigeon-toe gait. The surgical incision began from a point 2 cm inferior to the postero-superior iliac spine and curved towards the greater trochanter. The contracture tissues were exposed and released. The patient began active and passive hip flexion 2-3 days post-operatively. Results The contracture affected the gluteus maximus, gluteus medius, and even the piriform muscles. In one case, the ischial nerve was compressed by the fibrosed tissue. The post-op follow-up averaged ~8.1 years (ranging from ~2.5 to ~20.3 years). Twelve patients regained normal range of hip motion with full hip flexion. Three patients have limited flexion with the leg adducted, but they can squat with the knees in contact. No complication was observed in the 15 cases. The parents were satisfied with the result. Conclusions The contracted tissues in congenital abduction contraction of the hip may affect the gluteus maximus, medius, minimus muscles and small abduction rotation muscles. Adequate exposure is required for contracture release and to minimize nerve injury.