title: Long-term outcome of femoral derotation osteotomy in children with spastic diplegia.
abstract: Satisfactory short-term results after femoral derotation osteotomy (FDO) for the treatment of internal rotation gait in cerebral palsy have been reported by various authors. However, there are only a few longer-term studies reporting results 5 years after FDO and these are not in agreement. There are no reports on the clinical course beyond the pubertal growth spurt. 33 children with diplegia (n=59 legs, age: 10.5±3.6 years) and internally rotated gait were examined pre- (E0), 1 year (E1), 3±1 (E2) and 9±2 (E3) years after distal (27 legs) or proximal (32 legs) FDO as part of multilevel surgery, using standardized clinical exam and 3D gait-analysis at all examinations. The amount of intra-operative derotation averaged 25°. ANOVA was used for statistics (p<0.05). Mean hip internal rotation in stance at E0 of 17.3° was significantly changed to 1.0° of external rotation at E1 and was maintained at 4.2° at E3. The same clinical course was found for foot progression angle. The mid-point of passive hip rotation at E0 was 21°. This was significantly decreased to 6° at E1 and showed a small but significant increase reaching 12° at E3. The results of this study showed a good overall correction of internally rotated gait following FDO. These improvements were maintained at long-term follow-up after the pubertal growth spurt. Recurrence was observed in some cases with overall severe deterioration. In those patients persistent dynamic factors leading to recurrence should be further investigated.
authors: Paediatric Orthopaedics and Foot Surgery, Department of Orthopaedic and Trauma Surgery, Heidelberg University Clinics, Germany. thomas.dreher@med.uni-heidelberg.de
authors: Thomas
authors: T
authors: Dreher
authors: Sebastian I
authors: SI
authors: Wolf
authors: Daniel
authors: D
authors: Heitzmann
authors: Benedict
authors: B
authors: Swartman
authors: Waltraud
authors: W
authors: Schuster
authors: Simone
authors: S
authors: Gantz
authors: Sébastien
authors: S
authors: Hagmann
authors: Leonhard
authors: L
authors: Döderlein
authors: Frank
authors: F
authors: Braatz
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology*; D006621:Hip Joint / Q000502:physiology; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology*; D018570:Risk Assessment; D012399:Rotation; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome