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.
Keywords
bladder exstrophy - hip dysplasia - long-term outcome - exstrophy-epispadias complex
