Physician HonorHealth PM&R Tempe, Arizona, United States
Case Diagnosis: Hip dislocation, multiple sclerosis, spasticity
Case Description: A woman with history of multiple sclerosis and chronic right hip pressure ulcer presents after a ground level fall. She was found to have displaced right femoral neck fracture with tracking to the right hip wound. Patient underwent open reduction and internal fixation with antibiotic spacer placement. She was discharged to acute inpatient rehab, where she was noted to have weakness and significant spasticity of bilateral hip adductors. Shortly after rehab discharge, she presented to the emergency department with right hip dislocation. After revision surgery and increased baclofen dose, the patient was discharged back to acute inpatient rehab, and eventually discharged home with follow up in the outpatient physiatry clinic. Despite hip abduction brace, she suffered another right hip dislocation spontaneously reportedly while sleeping. She eventually underwent bilateral hip adductor and hamstring botulinum toxin injection with improvement in spasticity and range of motion.
Discussions: Spasticity management in the setting of multiple sclerosis is typically performed with the goal of increasing functional independence, decreasing pain, and facilitating optimal limb positioning and hygiene. In this case, this patient suffered recurrent atraumatic dislocation of her right hip articulating antibiotic spacer within days of discharge home in each instance. This patient’s spasticity was managed with an increased dose of baclofen initially, and eventually she benefited from botulinum toxin injection.
Conclusions: This case highlights how spasticity of the hip musculature may influence the stability of the hip joint following intra-articular surgery. This information can be used in counseling patients with spasticity of the risk of dislocation and importance of strict adherence to weight bearing and bracing precautions in conjunction with pharmacologic spasticity management.
