Morphological and Functional Hip Long-Term Results after Exstrophy Repair

Abstract

Introduction?Abnormalities of the bony pelvis in exstrophy-epispadias complex (EEC) and their possible relation to hip disease are well described. However, there is a lack of information about long-term orthopedic consequences and hip function in patients with EEC. Therefore, we investigated clinical and radiological results in an EEC patient cohort after long-term follow-up. Patients and Methods?We conducted a cross-sectional study using standardized radiography, clinical investigation, and the Harris hip score. Seventeen postpuberty consecutive unselected EEC patients (3 female, 14 male; mean age 18.2 years) that presented to our clinic due to urological procedures or routine check-up from 2010 to 2011 were included. All had undergone symphysis approximation with a traction bandage without osteotomy in early childhood. Radiological analysis was conducted offline by two independent investigators. Results?Radiological analysis showed a mean pubic diastasis of 5.1 cm (range 2.8?8.5 cm). Borderline hip dysplasia was present in four patients, one of them having had co-occurring developmental hip dysplasia in previous history. No severe dysplasia, subluxation, or luxation of the hip was found; however, one patient showed early hip arthrosis. Clinical examination revealed no relevant restriction of range of motion, although rotation and abduction were slightly altered in five patients. None of the EEC patients complained about pain or restriction in sports or daily activities. Harris hip score was perfect for all but one study participants. Conclusion?Despite EEC-specific hip morphology, long-term hip function is not impaired in patients after symphyseal approximation without osteotomy in the newborn period. The symphysis diastasis after this procedure is comparable to available postosteotomy data. The large majority of EEC patients did not show dysplastic or degenerative hip disease. Functional hip score results confirmed reasonable age-related hip function in nearly all examined patients. However, postnatal ultrasound hip screening is recommended to prevent and adequately treat potential co-occurring developmental hip dysplasia.

Recent Trends in the Management of Bladder Exstrophy: The Gordian Knot Has Not Yet Been Cut

“…Kertai et al was able to show that despite BE-specific hip morphology, long-term hip function was not impaired in adult adolescent patients after symphysial approximation without osteotomy in infancy. The symphysis diastasis after this procedure was also comparable to available post-osteotomy data in the long-term (43). In a case series published by Mushtaq et al (2), primary bladder closure without osteotomy and post-operative immobilization was successful in 70 of 74 patients (95%) in respect to bladder closure.…”

“…But there are also reports confirming no difference in success of bladder closure (1, 41, 42). However, it is known that symphysis diastasis recurs after all commonly used pelvic closure techniques (43). There are only a few studies dealing with pubic diastasis after various types of pelvic osteotomy in a reasonable follow-up (36–39).…”

Hip Prognosis in Patients With Congenital Diastasis of the Pubic Symphysis

“…[6][7][8][9][10]20 In contrast, persistent pubic symphysis diastasis has not been fully certified to be associated with prospective hip function in patients with EEC. 6,15,17,25,26 Sutherland et al 15 reported that pelvic osteotomy for closing the pubis does not improve gait patterns in patients with bladder exstrophy. Kantor et al 6 did not identify clear orthopaedic indications for early pubic correction osteotomy in patients with bladder exstrophy except for abdominal wall closure.…”

“…Several studies have suggested that pubic bone abnormalities in patients with EEC are potentially associated with the development of hip dysplasia including complete dislocation, requiring surgical interventions to the hip joint such as pelvic osteotomy or arthroplasty. [11][12][13][14] The incidence of hip dysplasia in patients with EEC has been reported to range widely, from 0% to 38%, [2][3][4][15][16][17] without clear descriptions about whether pubic symphysis diastasis is present. There have been no longitudinal studies of the type of pelvic abnormalities and patient characteristics associated with future hip dysplasia in patients with CDPS.…”

Health-Related Quality of Life in Patients with the Bladder Exstrophy-Epispadias Complex and Relationship to Incontinence and Sexual Factors: A Review of the Recent Literature

“…7 Adjunctive osteotomies and closure of the symphysis are frequently used, but is a subject of debate. 8,9 Urinary diversion (UD) encompasses surgical procedures which reroute and drain urine flow from its normal pathway, and it is used as secondary treatment after failed reconstructions in incontinent or continent versions, 1 but it can also be a primary intervention with cystectomy and a continent anal diversion. 10…”