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Updated: Jul 19, 2026
Three-Dimensional Preoperative Virtual Planning in Derotational Proximal Femoral Osteotomy
Published on: February 17, 2023
Internal rotation gait in spastic diplegia--critical considerations for the femoral derotation osteotomy
Insights
Femoral derotation osteotomy (FDO) in spastic diplegia can lead to under- or overcorrection, particularly in less affected limbs. Gait analysis is crucial for optimal surgical outcomes, suggesting FDO for internal hip rotation exceeding 15 degrees.
Area of Science:
- Orthopedic Surgery
- Pediatric Neurology
- Biomechanics
Background:
- Spastic diplegia often causes internally rotated gait in children.
- Femoral derotation osteotomy (FDO) is a surgical intervention to correct this gait abnormality.
- Assessing surgical outcomes and identifying optimal correction criteria is essential.
Purpose of the Study:
- To evaluate the accuracy of femoral derotation osteotomy (FDO) in spastic diplegic children.
- To investigate the occurrence of under- and overcorrection, especially concerning limb asymmetry.
- To determine the efficacy of the clinical midpoint versus gait analysis for surgical indication.
Main Methods:
- A cohort of 30 children with spastic diplegia underwent multilevel surgery including FDO.
- Pre- and 1-year postoperative assessments included clinical examination and instrumented gait analysis.
- Intraoperative derotation was guided by passive hip rotation, with K-wire control.
Main Results:
- The more involved limbs showed significant improvement in hip rotation post-FDO with low malcorrection rates (13%).
- The less involved limbs exhibited a high rate of malcorrection (59%), with outcomes worsening post-surgery.
- The clinical midpoint measurement proved insufficient for determining functional alignment, particularly in mildly affected limbs.
Conclusions:
- The clinical midpoint alone is inadequate for guiding FDO, especially in less affected limbs.
- Instrumented gait analysis is vital for precise surgical indication and outcome assessment in FDO.
- Recommend FDO when mean internal hip rotation in stance exceeds 15 degrees to optimize surgical results.
Abstract:
The purpose of this study was to assess under- and overcorrection following femoral derotation osteotomy (FDO) in spastic diplegic children with functionally compromising internally rotated gait, especially with respect to asymmetry. A total of 30 children with spastic diplegia and internally rotated gait underwent multilevel surgery including FDO and were assessed pre- and 1 year postoperatively by clinical examination and instrumented gait analysis. The amount of derotation was determined intra-operatively based on the neutral midpoint between passive internal and external hip rotation and was controlled with K-wires. Sixteen patients showed an asymmetry in mean hip rotation in stance of more than 10 degrees preoperatively. Accordingly, all legs were classified as the more or the less involved side. Improvement parameters were established for the evaluation of over- and undercorrection. For the clinical midpoint, no significant difference in change and improvement was found between the sides. The mean hip rotation in stance improved significantly in the more involved side with few incidences of mal-correction (13%). The less involved side, however, got worse due to a high occurrence of over- and undercorrections (59%). Hence the clinical midpoint as indication criterion does not give sufficient information about the functional alignment of the distal femur during gait, especially in legs with mild involvement. The study underlines the importance of gait analysis for indication in addition to the clinical midpoint. Taking into account the precision of gait analysis data and derotation amount, we suggest FDO to be carried out if the mean internal hip rotation in stance exceeds 15 degrees .