TY - JOUR
T1 - Long-term functional outcomes after an external femoral derotation osteotomy in individuals with cerebral palsy
AU - Boyer, Elizabeth R.
AU - Duffy, Elizabeth A.
AU - Walt, Kathryn
AU - Muñoz Hamen, Antonio
AU - Healy, Michael T.
AU - Schwartz, Michael H.
AU - Novacheck, Tom F.
N1 - Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - 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.
AB - 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.
KW - Cerebral palsy
KW - Femoral derotation osteotomy
KW - Function
KW - Gait
KW - Long-term
KW - Recurrence
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U2 - 10.1016/j.gaitpost.2021.04.029
DO - 10.1016/j.gaitpost.2021.04.029
M3 - Article
C2 - 33945965
AN - SCOPUS:85105015738
SN - 0966-6362
VL - 87
SP - 184
EP - 191
JO - Gait and Posture
JF - Gait and Posture
ER -