Impact of femoral derotation osteotomy on gait in ambulatory children with cerebral palsy: A systematic review and meta-analysis

TL;DR

Femoral derotation surgery improves gait in children with cerebral palsy, but clear guidelines for when to perform it are still lacking.

Contribution

This study provides a systematic review and meta-analysis of gait improvements after femoral derotation osteotomy in ambulatory children with cerebral palsy.

Findings

Significant improvements in pelvic and hip rotation, foot progression angle, and gait scores were observed post-surgery.

Intoeing gait was corrected in 74% of patients at one year and 69% at five years postoperatively.

The recurrence rate of intoeing gait was 13% after surgery.

Abstract

•Femoral Derotation surgery is often advised to treat in-toeing in cerebral palsy.•Overall results demonstrate improved gait function.•A clear, uniform surgical indication could not be determined.•Including the physical therapist in charge in the decision can be advised.

Femoral Derotation surgery is often advised to treat in-toeing in cerebral palsy.

Overall results demonstrate improved gait function.

A clear, uniform surgical indication could not be determined.

Including the physical therapist in charge in the decision can be advised.

Femoral derotation osteotomies (FDRO) are commonly performed in children with cerebral palsy who present with intoeing gait. However, the impact of FDRO on gait function and long-term results remains unclear.

This study aimed to quantify and qualify gait changes following gait-improving surgeries involving FDRO in ambulatory children with cerebral palsy and no associated hip pathologies, to support individualized decision-making regarding this invasive procedure.

A systematic search was conducted in May 2023 across six databases. Kinetic, kinematic, temporospatial parameters, and gait scores were extracted pre- and post-FDRO. A random-effects meta-analysis was performed.

Forty-six articles, including 1144 patients, were analyzed. Significant improvements were observed in pelvic rotation (mean change: 6.6°, 95 % confidence interval [CI]: 2.2 to 11), hip rotation (mean change:14.4°, 95 % CI:16.7 to –12.1), foot progression angle (mean change:16.1°, 95 % CI:18.3 to –14), and gait scores (standardized mean difference [SMD]: 0.99, 95 % CI: 0.52 to 1.47). The estimated improvement in gait scores corresponded to a 10-point increase in the Gait Deviation Index in the short term and 6.9 points in the long term. No deterioration was found in any assessed parameter. Intoeing gait was corrected in 74 % of patients at one year and in 69 % at five years postoperatively. The recurrence rate was 13 %.

While evidence suggests that femoral derotation osteotomies in ambulatory children with cerebral palsy without hip pathology improve overall gait function, the quality of available data is low. Patient-reported outcomes, including quality of life and satisfaction, are lacking. Definitive surgical indication could not be established; factors to consider include femoral anteversion, hip rotation at gait analysis, patient age, and relevant functional impairments.

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