title: Gait improvement surgery in ambulatory children with diplegic cerebral palsy.
abstract: OBJECTIVE
  Instrumented 3-D gait analyses (GA) in children with cerebral palsy (CP) have shown improved gait function 1 year postoperatively. Using GA, we assessed the outcome after 5 years and evaluated parental satisfaction with the surgery and the need for additional surgery.
  
  
  METHODS
  34 ambulatory children with spastic diplegia had preoperative GA. Based on this GA, the children underwent 195 orthopedic procedures on their lower limbs at a mean age of 11.6 (6-19) years. On average, 5.7 (1-11) procedures per child were performed. Outcome measures were evaluation of gait quality using the gait profile score (GPS) and selected kinematic parameters, functional level using the functional mobility scale (FMS), and the degree of parental satisfaction.
  
  
  RESULTS
  The mean GPS improved from 20.7° (95% CI: 19-23) preoperatively to 15.4° (95% CI: 14-17) 5 years postoperatively. There was no significant change in GPS between 1 and 5 years. The individual kinematic parameters at the ankle, knee, and hip improved statistically significantly, as did gait function (FMS). The mean parental satisfaction, on a scale from 0 to 10, was 7.7 (2-10) points. There was a need for additional surgical procedures in 14 children; this was more frequent in those who had the index operation at an early age.
  
  
  CONCLUSIONS
  The main finding was that orthopedic surgery based on preoperative GA gave marked improvements in gait function and quality, which were stable over a 5-year period. Nevertheless, additional orthopedic procedures were necessary in almost half of the children and further follow-up with GA for more than 1 year postoperatively is recommended in children with risk factors for such surgery.
authors: Department of Orthopaedic Surgery.
authors: Terje
authors: T
authors: Terjesen
authors: Bjørn
authors: B
authors: Lofterød
authors: Ingrid
authors: I
authors: Skaaret
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena / Q000502:physiology; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D051346:Mobility Limitation; D019637:Orthopedic Procedures / Q000379:methods*; D010290:Parents; D017060:Patient Satisfaction; D011184:Postoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
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