Q: My twin sons are 3 and half years old. Both had spina bifida at the time of birth and a neurosurgeon had operated the children within 48 hours of birth and repaired the meanengocele. Later on both had hydrocephalus and a shunt was planted to both at the age of 6 months. We are giving physiotherapy to lower limbs as both were paraplegic and stimulation also is being given from the past few years. They have responded slowly and the lower limbs have got back sensation. Now their feet are becoming tight as joints are stiffening. We were advised to go for surgery of the foot to release the tendons, so that they can be given calipers for trying to walk. We were advised to take x-ray of the pelvic portion it showed that one boy had bilateral dislocation of hips. This boy has developed considerable muscle strength and is doing pull ups in physiotherapy. The second boy was having right side hip joint dislocation and strength has very low muscular strength. Can a hip surgery be done to correct the dislocations? Will the surgery damage their knees further? Will foot surgery help in straightening the foot so that calipers can be given to make them walk. Please suggest some good hospitals and doctors who have a specialised knowledge in this critical field.

A:In a Spina Bifida child the ability to walk depends on the overall muscle power at the hip, knee and ankle. Despite a dislocation and a foot deformity the child may still be able to walk. Therefore, clinical assessment and charting of muscle power in all the muscles of the lower limb is important before we can prognosticate on any thing. The foot deformity can be corrected but the type of surgery can be decided only by assessing the foot clinically. Similarly at the hip dislocation can be reduced. However, the hip will stay in place only if muscle power around the hip can be balanced. To prevent a re-dislocation some muscle/tendon transfer will be required. This is possible only if there is sufficient power available in the muscles around the hip and they can be transferred to achieve balance of power of muscles. This again is possible only by clinical examination. The procedures are quite standard and there are no new major innovations. There are individual surgeons/institution based modifications which are expected. It is difficult to name good hospitals or doctors but I would suggest consult an orthopaedic surgeon in a centre where paediatric orthopaedic surgery is performed routinely. Orthopaedic surgeons dealing adult orthopaedic surgery alone will not suffice.