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CASE REPORT
Multifactorial pathological hip subluxation in neurofibromatosis type-1 (NF1) due to intra-articular plexiform neurofibroma, lumbar radiculopathy and neurofibromatous polyneuropathy
  1. Waqar Waheed1,
  2. Diego F Diego F Lemos2,
  3. Nelms Nathaniel Nelms3,
  4. Rup Tandan4
  1. 1Department of Neurology, University of Vermont, Burlington, Vermont, USA
  2. 2Department of Radiology, University of Vermont, Burlington, Vermont, USA
  3. 3Department of Orthopedics, University of Vermont, Burlington, Vermont, USA
  4. 4Department of Neurology, University of Vermont Medical Center, Burlington, Vermont, USA
  1. Correspondence to Dr Waqar Waheed, waqar.waheed{at}uvmhealth.org

Summary

Neurofibromatosis type-1 (NF1) is a multisystem disorder with very rare descriptions of hip instability. We report a case of a 37-year-old man with known NF1 and childhood-onset of left foot drop, who developed persistent left hip pain following a minor trauma. Physical examination revealed left-sided mild foot drop, hip abductor weakness, bilateral sensory loss in feet and an antalgic gait. Work-up revealed anterolateral subluxation of the left femoral head along with left hip plexiform neurofibroma (PN), dysplastic and degenerative changes, neurofibromatous neuropathy and chronic left L5 radiculopathy. Initial improvement after surgical resection of the PN was unsustained and followed by increasing pain and recurrent hip subluxation, prompting a total hip arthroplasty which resulted in marked improvement of symptoms. Our patient, unlike those in other reports, illustrates multiple aetiologies of hip dislocation in NF1 including local factors, lumbar radiculopathy and polyneuropathy, reinforcing the importance of a multidisciplinary approach in the management of such cases.

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Footnotes

  • Contributors WW contributed to the planning, conduct, acquisition of data or analysis, interpretation of data and reporting of the work described in the article. DFL contributed to acquisition of data or analysis and interpretation of data. NN contributed to acquisition of data or analysis and interpretation of data. RT contributed to planning, conduct acquisition of data or analysis and interpretation of data.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.