Adult Hip Flexion Contracture due to Neurological Disease: A New Treatment Protocol—Surgical Treatment of Neurological Hip Flexion Contracture

Congenital, traumatic, or extrinsic causes can lead people to paraplegia; some of these are potentially; reversible and others are not. Paraplegia can couse hip flexion contracture and, consequently, pressure sores, scoliosis, and hyperlordosis; lumbar and groin pain are strictly correlated. Scientific literature contains many studies about children hip flexion related to neurological diseases, mainly caused by cerebral palsy; only few papers focus on this complication in adults. In this study we report our experience on surgical treatment of adult hip flexion contracture due to neurological diseases; we have tried to outline an algorithm to choose the best treatment avoiding useless or too aggressive therapies. We present 5 cases of adult hips flexion due to neurological conditions treated following our algorithm. At 1-year-follow-up all patients had a good clinical outcome in terms of hip range of motion, pain and recovery of walking if possible. In conclusion we think that this algorithm could be a good guideline to treat these complex cases even if we need to treat more patients to confirm this theory. We believe also that postoperation physiotherapy it is useful in hip motility preservation, improvement of muscular function, and walking ability recovery when possible. 1. Introduction Congenital, traumatic, or extrinsic causes can lead adults to paraplegia; some of these are potentially reversible as peripheral neuropathy drugs and alcohol induced [1] and others are not. Depending on the level and on the extent of spinal damage, there can be a partial or complete loss of sensation and function in the affected limbs. Sexual impotence and urinary and fecal incontinence may also occur. Some of these patients can walk with aids, but most of them are dependent on wheelchair and forced to sitting position. In these cases, as consequence of the prolonged sitting position, hips can develop a flexion attitude that results in dysplasia, dislocation, or ankylosis of the hips [2]. These patients may develop hip dislocation over time, with an incidence rate reported to be between 18 and 59% [3]. This is the consequence of muscular imbalance and capsular retraction that can cause a subluxation of the femoral head and finally a complete dislocation [4]. Fixed hip flexion can also lead to marked lumbar hyperlordosis, pelvic anteversion, and sometimes horizontal sacrum [5, 6]. This postural attitude can evoke lumbar and groin pain which can be associated with alterations of sensitivity. Moreover the decrease or loss of sensitivity combined with hip flexion and