DOI: 10.1097/bpo.0000000000003491 ISSN: 0271-6798

Comparison of Changes in Gait Kinematics and Surgical Outcomes After Proximal and Distal Femoral Derotational Osteotomy in Children With Cerebral Palsy

Reiko Hara, Susan A. Rethlefsen, Alyssa Ponrartana, Tishya A.L. Wren, Robert M. Kay
Show PDF Cite

Background:

It remains uncertain whether proximal or distal femoral derotational osteotomy is preferable for correcting excessive internal hip rotation and foot progression in children with cerebral palsy (CP). This study compares gait kinematic and surgical outcomes between the 2 types of osteotomies. The relationship between the amount of surgical correction and postoperative gait changes was also explored.

Methods:

Retrospective data of children who underwent femoral derotational osteotomy with preoperative and postoperative gait analysis were compared between proximal and distal osteotomies for various surgical outcomes. Mean hip rotation and foot progression angles during the stance phase of gait were averaged over several representative strides for each patient, limb, and visit and compared between groups before and after surgery using linear mixed models accounting for repeated measures within each participant and covariates that differed between groups. The correlation between the amount of surgical correction and the change in hip rotation angle during gait was examined.

Results:

A total of 91 limbs in 52 patients with proximal and 177 limbs in 112 patients with distal osteotomies were analyzed. Both groups improved significantly in hip rotation and foot progression angles during the stance phase of gait postoperatively ( P <0.001). The complication rate was higher in the distal group, although the difference was not statistically significant (8% vs. 3%, P =0.13). Additional surgery for isolated hardware removal was performed for 22/91 (24%) limbs with proximal osteotomies ( P <0.001). A higher correlation between the amount of surgical correction and the change in hip rotation angle was observed in patients with unilateral femoral osteotomy ( r =−0.60, P <0.0001), hemiplegic CP ( r =−0.71, P <0.0001), and proximal osteotomy without varus correction ( r =−0.63, P <0.0001).

Conclusions:

Both proximal and distal femoral derotational osteotomies are clinically effective in reducing excessive hip internal rotation and normalizing foot progression during gait in children with CP. Consideration in selecting the site of the procedure should include potential risks and benefits for postoperative complications, morbidity, and the possibility of additional surgery.

Level of Evidence:

Therapeutic studies—investigating the results of treatment, Level III.

More from our Archive