Not only the feet and legs are affected in people who suffer from this disease. Also the hips are affected, producing pain that appears in the 2nd -3rd decade of life. But why is hip dysplasia worse in patients with Charcot-Marie-Tooth? Because the acetabulum is more deformed, shallow and has more anteversion than in a developmental dysplasia. But also hip subluxation is more severe.
Charcot-Marie-Tooth hip displasia (CMTHD) is more prevalent presented with moderate to severe arthritis. Hip pain on the groin, irradiated to the thigh is the most common location. The pain interferes with walking and with many of your activities. The muscles called the gluteus medius and minimus. Being referred to as the rotator cuff of the hip, may be affected by the disease. Producing a kind of limp that is called Trendelenburg gait.
WHAT CRITERIA DO WE USE IN THE TREATMENT OF HIP DYSPLASIA DUE TO CMT?
Among our patients we have almost 7% who have hip dysplasia. This together with the deformity of the feet and legs, makes walking very difficult. The treatment that we apply depends on several parameters. The age of the patient, the degree of subluxation, or the percentage that the head of the femur is covered by the acetabulum. Also if there are already signs of arthritis, which is a worse prognosis to preserve the joint.
HOW DO WE TREAT HIP DYSPLASIA?
In young patients between 10 to 20 years, without signs of osteoarthritis and with a subluxation of the head of the femur. We perform operations that provide coverage, such as the Chiari osteotomy or a triple pelvis osteotomy of the Tönnis. Apparently they seem very complicated surgeries, but they are simpler and give good coverage to the head of the femur. Sometimes they are combined with another cut that we make in the neck of the femur, to correct the rotation and shorten the bone. In this way we get to introduce the head inside the pelvis. In these patients we manage to repair the dysplasia and they can walk without problem.
When we do a triple pelvic osteotomy, the pelvis is cut at three levels and we rotate the acetabulum to cover the femur.
HOW DO WE TREAT SUBLUXATED HIPS THAT HAVE ARTHRITIS?
In these cases, we have already arrived late to preserve the hip, since the patient has lost the articular cartilage. The joint has arthritis, which produces severe pain when walking. That’s why the option is to implant a total hip prosthesis. This is the case of this patient with cavus varus feet, knock- kneed (valgus) and arthritis of the right hip. Now her quality of life has improved remarkably, returning to work in the family restaurant.
Therefore, a surgeon specialized in treating patients with Charcot-Marie-Tooth, should perform the integral treatment of the lower limbs. Not only are the feet, but also the legs and hips.
We continue integrating the treatments of patients with this disease, restoring their ability to walk steadily and painlessly.