Metaphyseal femoral resection with structured myoplasty in non-ambulatory patients with neurologic hip dislocation: long-term outcomes on pain relief and complication rates.

backgroundHip dislocation in non-ambulatory patients with severe neurological impairment is a frequent and debilitating complication, often associated with chronic pain, hygiene difficulties, and sitting intolerance. In advanced cases, reconstructive options are limited due to severe joint deformity. Proximal femoral resection represents a salvage technique aimed at pain relief but long-term outcome data remain limited. This study aimed to evaluate the long-term clinical and radiographic outcomes of metaphyseal femoral resection with structured myoplasty in non-ambulatory patients with neurologic hip dislocation.

methodsThis retrospective observational study included non-ambulatory patients with symptomatic unilateral hip dislocation and severe neurological impairment treated at our institution. Patients who underwent metaphyseal proximal femoral resection with structured myoplasty using the tensor fasciae latae and sartorius muscles were compared with a control group of individuals who met surgical indications but did not undergo the surgical procedure. Long-term follow-up using clinical and radiographic assessment was carried out. Primary endpoints were pain (FLACC scale), postoperative complications, and the incidence of pressure ulcers. Secondary outcomes included femoral stump migration and heterotopic ossification on radiographs.

resultsA total of 54 patients were included in the study.The operated group (n = 37) had a mean age of 16.6 ± 5.1 years, whereas the control group (n = 17) had a mean age of 18.1 ± 3.4 years.Operated patients showed a rapid and sustained reduction in pain, with FLACC scores decreasing from a baseline mean of 8.3 to 0.8 at one month, and 0.0 at 12 years (p < 0.0001). Pain scores in the control group remained significantly higher throughout follow-up (p < 0.0001 at all timepoints). No operated patients developed pressure ulcers during follow-up, compared to 23.5% of the control group (p = 0.030). Femoral migration was observed radiographically in 24.3% of cases, with a mean displacement stabilizing at 2.4 cm at long-term follow-up; however, it was clinically silent and did not require reoperation. Heterotopic ossification occurred in 21.6% of operated hips, was limited to low-grade forms, and was detected only on radiographs, without clinical symptoms or need for treatment. Significant complications occurred in 5.4% of the patients in the operated group.

conclusionsMetaphyseal femoral resection with structured myoplasty is a safe and effective surgical option for non-ambulatory patients with neurologic hip dislocation, providing long-term pain relief and reducing the risk of pressure ulcers. These findings support its early consideration in appropriately selected patients, regardless of underlying neurologic diagnosis.