Triple arthrodesis for children with spastic cerebral palsy

A retrospective review was done of 20 children with spastic cerebral palsy who had had a total of 25 triple arthrodeses at Rancho Los Amigos Hospital. The average age at the time of surgery was 15.5 years and average follow-up was 4.5 years. Indications for surgery were progressive deformity (15) and relief of pain (five). The deformities was planovalgus (12), equinovalgus (six), equinovarus (six) and calcaneovalgus (one). All 13 patients with braces had problems in wearing them. Two patients were non-ambulatory preoperatively and remained so after fusion. Of the 18 who were ambulatory preoperatively, 15 remained so and there was no change in the type of ambulation: the other three stopped ambulating. Three children were made independent of braces. It is concluded that triple arthrodesis is an excellent procedure for children with spastic cerebral palsy, to correct deformity and relieve pain, but it should be done while the children are still walking for the best chances of continued ambulation.