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Current Variation in the Postoperative Management of Patients With Cerebral Palsy Undergoing Lower Extremity Surgery:
Arianna Trionfo1, Christina Herrero1, Jason J Howard1
1Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE, USA.
Insights
Postoperative management for pediatric lower extremity surgery in cerebral palsy (CP) lacks consensus. Significant variation exists in weight-bearing, immobilization, and rehabilitation, impacting patient outcomes.
Area of Science:
- Orthopaedic surgery
- Pediatric rehabilitation
- Cerebral palsy (CP) management
Background:
- Children with cerebral palsy (CP) frequently develop lower limb deformities necessitating surgical intervention.
- Optimal postoperative care, including weight-bearing, immobilization, and rehabilitation, remains undefined for these young patients.
Purpose of the Study:
- To investigate current postoperative management practices for youth with cerebral palsy (CP) undergoing lower extremity surgery.
Main Methods:
- An electronic survey was distributed to 114 orthopaedic surgeons specializing in CP.
- The survey assessed weight-bearing, immobilization, and rehabilitation protocols for seven common lower extremity procedures.
- Consensus was defined as greater than 75% agreement.
Main Results:
- A 57% response rate was achieved from 65 surgeons.
- Consensus was reached on only 4% of survey questions, indicating significant practice variation.
- Immediate weight-bearing was agreed upon for soft-tissue procedures, and casting for distal bony procedures.
Conclusions:
- Substantial heterogeneity exists in postoperative care for pediatric CP patients after lower extremity surgery.
- Lack of consensus on weight-bearing, immobilization, and rehabilitation planning may affect functional outcomes.
- Further research is crucial to establish standardized postoperative guidelines.
Background:
Children with cerebral palsy (CP) often develop lower limb deformities requiring surgical management. However, optimal postoperative management strategies-including weight-bearing progression, immobilization, and rehabilitation protocols-remain unclear. The purpose of this study was to evaluate current postoperative practices following lower extremity surgery in youth with CP.
Methods:
A 42-question electronic survey was sent to 114 practicing orthopaedic surgeons in the American Academy for Cerebral Palsy and Developmental Medicine. Six questions regarding seven surgical procedures (pelvic osteotomy, proximal femoral osteotomy, tibial osteotomy, isolated soft-tissue procedures, foot osteotomies, and foot fusions) were presented. Surgeons were asked about weight bearing, immobilization, initiation of physical therapy, standardized protocols, evaluation for inpatient rehabilitation, and educational sessions. Consensus was defined as >75% agreement for a given response (based on Delphi methodology).
Results:
Sixty-five surgeons from North America responded (57% response rate), with predominantly neuromuscular practices. Consensus was reached on only four of 42 questions (9.5%). Regarding weight bearing, 87.7% of surgeons allowed immediate weight bearing after isolated soft-tissue procedures. For immobilization, cast use reached consensus only for distal lower extremity surgeries including tibial osteotomy (95%), foot osteotomy (98%), and foot fusion (100%). Concerning rehabilitation and planning, no consensus was reached for any item.
Conclusions:
There was substantial heterogeneity in postoperative practices for children with CP undergoing lower extremity surgery. Other than immediate weight bearing after soft-tissue procedures and casting after distal bony procedures, no clear consensus emerged for weight-bearing progression, immobilization method, or rehabilitation planning. This variability may influence functional outcomes and patient satisfaction. Future studies regarding postoperative practices are warranted.
Key Concepts:
(1)Postoperative management varies widely for cerebral palsy (CP) patients after lower extremity surgery.(2)Weight-bearing protocols vary: some allow early weight bearing, while others restrict for 8 weeks.(3)No standardized guidelines exist for rehab after lower extremity surgery in CP.
Level Of Evidence:
IV.
