Factors associated with recurrence after femoral derotation osteotomy in cerebral palsy.
Femoral derotation osteotomy (FDO) as gold standard treatment for internal rotation gait in cerebral palsy (CP) leads to satisfying short-term results, whereas rates of recurrence up to 33% are reported in long-term outcome studies. The purpose of this study was therefore to identify factors contributing to recurrence of internal rotation gait in patients with CP who were treated with FDO in childhood. 70 patients (age: 10 (± 3.3) years at surgery) with bilateral CP and internal rotation gait were examined pre-, one year and at least five years (mean 8 ± 2 years) postoperatively after distal or proximal FDO, using standardized clinical examination and 3D gait-analysis. 27 patients had a good hip rotation one year postoperatively (between 5° external and 15° internal for both limbs) and were considered for the analysis of factors contributing to recurrence of internal rotation gait. Regarding all included patients both mean hip rotation and foot progression angle improved significantly (p < 0.001) from pre- to postoperative. A significant deterioration in hip rotation (more involved side) (p < 0.001) from one year postoperatively to the long-term follow-up can be observed. Younger age, reduced hip joint impulse, increased plantar flexion and internal foot progression angle postoperatively could be identified as factors for recurrence. FDO on average leads to a satisfactory correction of internal rotation gait. In order to improve the long-term outcome after FDO the time of multilevel surgery should be indicated as late as possible and the different factors leading to potential recurrence should be considered.
Paediatric Orthopaedics and Foot Surgery, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.
M
M
Niklasch
Paediatric Orthopaedics and Foot Surgery, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.
S I
SI
Wolf
Paediatric Orthopaedics and Foot Surgery, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.
M C
MC
Klotz
Paediatric Orthopaedics and Foot Surgery, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.
A
A
Geisbüsch
Paediatric Orthopaedic Department, University Children's Hospital Basle (UKBB), Basle, Switzerland.
R
R
Brunner
Orthopaedic Hospital for Children, Behandlungszentrum Aschau, Aschau, Germany.
L
L
Döderlein
Paediatric Orthopaedics and Foot Surgery, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: thomas.dreher@med.uni-heidelberg.de.
T
T
Dreher
D000293:Adolescent; D060750:Bone Anteversion / Q000601:surgery*; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D005684:Gait; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
Cerebral palsy; Femoral derotation osteotomy; Gait analysis; Internal rotation gait; Long-term outcome