Presence of coxofemoral dislocation: only one hip presented lateral subluxation. The others appeared reduced. Heterotopic ossification: selleck Belinostat of the 30 hips analyzed, in five we identified heterotopic ossification – classified by Brooker et al.7 as degree II and III, while four hips presented increase of coxofemoral periarticular density and one was in topography lateral to the ilium. (Figures 2 and and33) Figure 2 Heterotopic ossification (degree II) present in the enhanced periarticular region. Figure 3 Note the exuberant periarticular heterotopic ossification in the right hip (degree III) and degenerative alterations in the left hip. Other findings: increase of anterior acetabular coverage and shepherd’s crook deformity of the femur were identified in one hip, while radiolucent image was observed in the femoral head in another hip, compatible with a probable diagnosis of osteoid osteoma.

DISCUSSION Most of the time, spinal cord-injured patients cannot rely on proprioception to assist in joint protection, due to their neurological impairment. These individuals only have anatomical mechanisms as protective factors. Possible trauma, caused even by minimal manipulation, leads to potential risks of neuropathic arthropathy due to chondrolysis and erosion of the articular cartilage.8,9 As a consequence of this process, other abnormalities may arise, such as bone fissures, formation of subchondral cysts, osteophytes, decrease and impairment of the joint space and articular incongruity, suggesting the early onset of osteoarthritis in these patients.

The radiographic findings of these patients with spinal cord injury in this study indicate a high rate of articular impairment of the hip after a few years of clinical evolution of the neuromotor deficit. Only seven (23%) of the hips evaluated had no evidence of damage to the articular surface. However, as there is a multidisciplinary follow-up of these patients at the Laboratory of Biomechanical Rehabilitation of the Musculoskeletal System, the expected total incidence of degenerative alterations was lower. The prevalence of heterotopic ossification found in the patients studied (5 of the 30 hips: 16.6%) was close to the parameters described in the literature.2-4 This comorbidity is associated with joint pain and limitation of range of motion, which implies difficulty in the handling of these individuals, both for hygiene care and for rehabilitation, producing a deterioration in the quality of life.

The radiograph, besides being a highly accessible, low-cost examination, enables a good evaluation of bone structures, favoring the identification of a great deal of degenerative and morphologic joint alterations. It Cilengitide is also the examination of choice for the detection of heterotopic ossification, which is a frequent condition in spinal cord injury patients.10 Therefore, it should be used routinely in the assessment of these patients.