AI Article Synopsis
- The study investigates the long-term effects of femoral derotation osteotomy (FDO) during childhood on adults with bilateral cerebral palsy, comparing outcomes between those who had the surgery and those who did not.
- Sixty-one adults were examined 13-25 years after their initial assessments or surgeries, focusing on gait, physical tests, and functional measures, revealing that both FDO and non-FDO groups had similar outcomes in key metrics like hip rotation and pain levels.
- Findings suggest that while FDO may not be necessary for achieving comparable functional results in higher functioning individuals, it does offer improvements in strength and mobility in the earlier years following surgery.
Article Abstract
Background: It is unknown how a femoral derotation osteotomy (FDO) during childhood affects functional outcomes in adulthood among individuals with bilateral cerebral palsy (CP).
Research Questions: How do long-term functional outcomes after an FDO compare to matched individuals who did not have an FDO? How do outcomes change over time?
Methods: We queried the gait laboratory database for individuals who underwent an external FDO in childhood and were currently ≥25 years old. Participants returned for a long-term analysis (gait, physical examination, functional tests, imaging, questionnaires). The matched non-FDO group included only individuals in Gross Motor Function Classification System levels I-II, yielding three groups (non-FDO I-II, FDO I-II, FDO III-IV).
Results: Sixty-one adults (11 non-FDO, 34 FDO I-II, 16 FDO III-IV) returned 13-25 years after baseline (non-FDO) or surgery (FDO). The non-FDO and FDO I-II groups were matched at baseline on most variables, except the FDO group had weaker hip abductors. At long-term, groups were similar on gait variables (median long-term hip rotation [primary outcome], non-FDO: -4°, FDO I-II: -4°, FDO III-IV: -5°), hip abduction test, fear of falling, and most pain measures despite anteversion being 29° greater in the non-FDO group. The FDO I-II group reported more falls than the non-FDO group. All groups improved on hip rotation, foot progression, and hip abductor strength. Speed and step length decreased/tended to decrease for all three groups. Hip abduction moment and gait deviation index did not change. Improvements in the FDO groups were maintained from short- to long-term.
Significance: These results challenge the notion that an FDO is necessary to correct mean stance hip rotation for higher functioning individuals since nearly identical results were achieved by adulthood in the non-FDO I-II group. However, an FDO provides improvement earlier and maintenance from short- to long-term. This should factor into the shared decision-making process.
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| http://dx.doi.org/10.1016/j.gaitpost.2021.04.029 | DOI Listing |
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Long-term functional outcomes after an external femoral derotation osteotomy in individuals with cerebral palsy.
Gait Posture
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Gillette Children's Specialty Healthcare, 200 University Avenue East, Saint Paul, MN, 55101, United States; University of Minnesota, Orthopedic Surgery, 2450 Riverside Ave, Minneapolis, MN, 55454, United States. Electronic address:
Article Synopsis
- The study investigates the long-term effects of femoral derotation osteotomy (FDO) during childhood on adults with bilateral cerebral palsy, comparing outcomes between those who had the surgery and those who did not.
- Sixty-one adults were examined 13-25 years after their initial assessments or surgeries, focusing on gait, physical tests, and functional measures, revealing that both FDO and non-FDO groups had similar outcomes in key metrics like hip rotation and pain levels.
- Findings suggest that while FDO may not be necessary for achieving comparable functional results in higher functioning individuals, it does offer improvements in strength and mobility in the earlier years following surgery.
Factors affecting GDI improvement after single event multilevel surgery in patients with cerebral palsy.
Gait Posture
July 2020
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi 13620, Republic of Korea. Electronic address:
Background: Pathologic gait is common in patients with cerebral palsy (CP). Single-event multilevel surgery (SEMLS) is a combination of surgical procedures to improve pathologic gait in patients with CP. However, the effect of each procedure is difficult to predict.
View Article and Find Full Text PDFOutcomes of Orthopaedic Surgery With and Without an External Femoral Derotational Osteotomy in Children With Cerebral Palsy.
J Pediatr Orthop
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Background: Ambulatory children with cerebral palsy (CP) often present with multiple deviations in all planes including increased internal hip rotation during gait. Excessive femoral anteversion is a common cause of deviation managed surgically with an external femoral derotational osteotomy (FDO). The purpose of this study was to evaluate the gait and functional outcomes of a group of subjects with CP who underwent surgical intervention that included an FDO compared with a match group with indications of internal hip rotation that did not receive an FDO.
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