**5. Hip**

Thirty percent of the spina bifida patients present with hip dislocations either at birth or during their childhood (**Figure 6**) [24]. The number can go up to 50% if we include hip subluxations. Dislocation occurs more commonly when the spinal cord defect is at the L3 level and the patient has a muscle imbalance with unopposed hip flexion and adduction. The ability of a patient to walk does not seem to be affected by dislocation of the hips and surgical relocation does not necessarily translate in a functional improvement [25]. Additionally, this problem does not seem to cause pain to the patients. For all these reasons many orthopedic surgeons advocate against putting the patients through complex osseous and soft tissue procedures and surgical intervention can even be considered controversial in such scenario where a benefit will not necessarily be obtained and such interventions are not exempt from surgical complications [26, 27].
