title: Superior functional outcome after femoral derotation osteotomy according to gait analysis in cerebral palsy.
abstract: The femoral derotation osteotomy (FDO) is seen as the golden standard treatment in children with cerebral palsy and internal rotation gait. Variable outcomes with cases of over- and undercorrection mainly in the less involved patients have been reported. The determination of the amount of derotation is still inconsistent. 138 patients (age: 11 (± 3.3) years) with cerebral palsy and internal rotation gait were examined pre- and 1 year postoperatively after distal or proximal FDO, using standardized clinical examination and 3D gait analysis. Three groups were defined retrospectively depending on the amount of derotation in relation to the mean hip rotation in stance (MHR) during gait analysis: Group A (derotation angle > MHR + 10°), Group B (derotation angle = MHR ± 10°), Group C (derotation angle <MHR-10°), and compared according to their postoperative mean hip rotation. ANOVA with Bonferroni post hoc test was used for statistics (p < 0.05). Group B had the greatest benefit with the highest rate (86%) of good results (postoperative MHR = ± 15°). In contrast there were 14% cases of overcorrection and 5% cases of deterioration in Group A with only 81% good results and only 79% good results in Group C. It can be concluded, that it is less likely to have unsatisfactory outcomes if the amount of FDO is defined according to the findings of gait analysis compared with clinical examination.
authors.affiliation: Pediatric Orthopaedics and Foot Surgery, Clinic for Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Niklasch
authors.affiliation: Pediatric Orthopaedics and Foot Surgery, Clinic for Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany. Electronic address: thomas_dreher@hotmail.com.
authors.forename: T
authors.initials: T
authors.lastname: Dreher
authors.affiliation: Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstrasse 18, 83229 Aschau i. Chiemgau, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Döderlein
authors.affiliation: Pediatric Orthopaedics and Foot Surgery, Clinic for Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
authors.forename: S I
authors.initials: SI
authors.lastname: Wolf
authors.affiliation: Pediatric Orthopaedics and Foot Surgery, Clinic for Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Ziegler
authors.affiliation: Paediatric Orthopaedic Department, University Children's Hospital Basle (UKBB), Spitalstrasse 33, 4056 Basel, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Brunner
authors.affiliation: Paediatric Orthopaedic Department, University Children's Hospital Basle (UKBB), Spitalstrasse 33, 4056 Basel, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Rutz
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005269:Femur / Q000601:surgery*; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods; D011184:Postoperative Period; D012189:Retrospective Studies; D012399:Rotation; D016896:Treatment Outcome
keywords: Cerebral palsy; Femoral derotation osteotomy; Indication; Internal rotation gait; Outcome