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Published on: March 23, 2019
Gait improvement surgery in ambulatory children with diplegic cerebral palsy
Terje Terjesen1, Bjørn Lofterød, Ingrid Skaaret
1Department of Orthopaedic Surgery.
Insights
Orthopedic surgery guided by gait analysis (GA) in children with cerebral palsy (CP) significantly improves gait function for five years. However, nearly half of patients require further surgery, indicating a need for long-term monitoring.
Area of Science:
- Orthopedics
- Pediatrics
- Biomechanical Engineering
Background:
- Instrumented 3-D gait analyses (GA) in children with cerebral palsy (CP) have demonstrated short-term improvements in gait function.
- Long-term outcomes and parental satisfaction following CP surgery remain areas for further investigation.
Purpose of the Study:
- To assess the 5-year post-operative outcomes of orthopedic surgery guided by GA in children with spastic diplegia.
- To evaluate parental satisfaction with the surgical intervention and identify the need for subsequent surgical procedures.
Main Methods:
- 34 ambulatory children with spastic diplegia underwent 195 orthopedic procedures based on preoperative GA.
- Outcome measures included gait quality (gait profile score - GPS), kinematic parameters, functional mobility scale (FMS), and parental satisfaction.
- Follow-up was conducted at 5 years post-operatively.
Main Results:
- The mean GPS improved significantly from 20.7° preoperatively to 15.4° at 5 years post-operatively, with no significant change between 1 and 5 years.
- Statistically significant improvements were observed in individual kinematic parameters (ankle, knee, hip) and functional mobility (FMS).
- Mean parental satisfaction was 7.7/10, and 14 children (41%) required additional surgeries, more frequently in those operated on at a younger age.
Conclusions:
- Orthopedic surgery based on GA provides sustained improvements in gait function and quality for at least 5 years in children with CP.
- Nearly half of the children required additional procedures, highlighting the necessity for extended post-operative follow-up.
- Children with risk factors for re-operation benefit from continued gait analysis monitoring beyond the first year.
Background And Purpose:
Instrumented 3-D gait analyses (GA) in children with cerebral palsy (CP) have shown improved gait function 1 year postoperatively. Using GA, we assessed the outcome after 5 years and evaluated parental satisfaction with the surgery and the need for additional surgery.
Patients And Methods:
34 ambulatory children with spastic diplegia had preoperative GA. Based on this GA, the children underwent 195 orthopedic procedures on their lower limbs at a mean age of 11.6 (6-19) years. On average, 5.7 (1-11) procedures per child were performed. Outcome measures were evaluation of gait quality using the gait profile score (GPS) and selected kinematic parameters, functional level using the functional mobility scale (FMS), and the degree of parental satisfaction.
Results:
The mean GPS improved from 20.7° (95% CI: 19-23) preoperatively to 15.4° (95% CI: 14-17) 5 years postoperatively. There was no significant change in GPS between 1 and 5 years. The individual kinematic parameters at the ankle, knee, and hip improved statistically significantly, as did gait function (FMS). The mean parental satisfaction, on a scale from 0 to 10, was 7.7 (2-10) points. There was a need for additional surgical procedures in 14 children; this was more frequent in those who had the index operation at an early age.
Interpretation:
The main finding was that orthopedic surgery based on preoperative GA gave marked improvements in gait function and quality, which were stable over a 5-year period. Nevertheless, additional orthopedic procedures were necessary in almost half of the children and further follow-up with GA for more than 1 year postoperatively is recommended in children with risk factors for such surgery.
