Hip arthrodesis following DDH

by Kate
(Denmark)

Hi,

I was born with DDH. It went undiagnosed for 9 months until I was sent to a specialist who attempted to correct my problem. After splints, and several failed arthroplasties, the only option was to perform a hip arthrodesis, where my hip was set at approximately 30 degrees flexion, and I can't remember the degrees adduction. The fusion was performed when I was 12, and I am now 30.

Since then I have developed a slight ipsilateral valgus knee (9 degrees valgus I believe), and have had stiffness in my lower back, which is to be expected.

I have also been experiencing sharp pain in my buttock, and today extreme thigh pain (contralateral) which presents itself as a burning sensation after rest, which causes me to limp for about an hour, and then the pain disappears.

I am wondering if this could be MERALGIA PARESTHETICA. My physiotherapist tends to manipulate my spine, and massage my neck, without discussing ways to prevent further problems.

I train at the gym reasonably frequently, to keep my thigh muscles, and muscles supporting the knee (especially vastus medialis) strong. I am wondering if it would be better to see a Chiropractor. Do you have any thoughts about my case? I would love to hear from you.

Kate

Hello Kate,
Alas all doctors screw up sometimes, I know I do, but missing that hip dysplasia was a very serious ommission by the paediatrician. That splint has to be applied before 6 months.

You don't say where in your thigh you have the pain. Just to confirm... it's not in the leg where you have the hip arthrodesis?

The Superficial Femoral Cutaneous nerve supplies the side of the thigh, and a variant can go into the groin and anterior thigh. Definitely not the back of the thigh- then you are looking at the sciatic nerve.

Do you have any pain/ stiffness in the upper lumbar spine? When you bend backwards and sideways, is it stiff in the back, and does it radiate to the thigh?

Do you have any pain in the groin, and just medial to the ASIS where the nerve emerges from the pelvis?

It's an area that I have a particular interest in, but you would need to ask. I suspect a fair number of chiropractors (Physios, and medics too) have never heard of MP. They have to address the upper thigh and the high lumbar spine. Both, or it won't get better.

Important to rule out a Femoral nerve lesion, then the quad reflex may weaken, the muscle too.

But of course, it could also be a sacro-iliac joint problem. What's needed is a careful,thorough exam. Take your X-rays to the chiro.

Try the Maignes syndrome exercises at Chiropractic-Books.com. They might help.

Look too at a short leg. Even a few mm of a leg length deficiency can make a huge difference. Don't believe the stuff that it must be 15mm different to be clinically significant. Bunkum.

I hope this has contributed.

Dr B