title: Long-term changes in femoral anteversion and hip rotation following femoral derotational osteotomy in children with cerebral palsy.
abstract: Excessive femoral anteversion is common in cerebral palsy (CP), is often associated with internal hip rotation during gait, and is frequently treated with a femoral derotational osteotomy (FDO). Concerns exist regarding long-term maintenance of surgical outcomes. Past studies report varying rates of recurrence, but none have employed a control group.
  
  
  
  We conducted a retrospective analysis examining long-term (∼5 years) changes in anteversion and hip rotation following FDO in children with CP. We included a control group that was matched for age and exhibited excessive anteversion (>30°) but did not undergo an FDO. Anteversion, mean stance hip rotation, and rates of problematic remodeling and recurrence were assessed (>15° change and final level outside of normal limits).
  
  
  
  The control group was reasonably well matched, but exhibited 9° less anteversion and 3° less internal hip rotation at the pre time point. At a five year follow-up, the FDO group had less anteversion than the control group (20° vs. 35°, p<0.05). The mean stance phase hip rotation did not differ between the groups (4° vs. 5°, p=0.17). Over one third of limbs remained excessively internal in both groups (FDO: 34%, Control: 37%). Rates of problematic recurrence and remodeling were low (0%-11%).
  
  
  
  An FDO is an effective way to correct anteversion in children with CP. Long-term hip rotation is not fully corrected by the procedure, and is not superior to a reasonably well matched control group. Rates of problematic recurrence and remodeling are low, and do not differ between the groups.
authors.affiliation: Gillette Children's Specialty Healthcare, Center for Gait and Motion Analysis, St. Paul, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Boyer
authors.affiliation: Gillette Children's Specialty Healthcare, Center for Gait and Motion Analysis, St. Paul, USA; University of Minnesota, Department of Orthopaedic Surgery, Minneapolis, USA.
authors.forename: Tom F
authors.initials: TF
authors.lastname: Novacheck
authors.affiliation: Gillette Children's Specialty Healthcare, Center for Gait and Motion Analysis, St. Paul, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Rozumalski
authors.affiliation: Gillette Children's Specialty Healthcare, Center for Gait and Motion Analysis, St. Paul, USA; University of Minnesota, Department of Orthopaedic Surgery, Minneapolis, USA. Electronic address: schwa021@umn.edu.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D005260:Female; D005269:Femur / Q000601:surgery*; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology*; D006621:Hip Joint / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010027:Osteotomy / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D012399:Rotation; D016896:Treatment Outcome
keywords: Cerebral palsy; Femoral derotational osteotomy; Gait analysis; Outcome; Recurrence; Torsion