Article

Femoral derotation osteotomy (FDO) as gold standard treatment for internal
rotation gait in cerebral palsy (CP) leads to satisfying short-term results,
whereas rates of recurrence up to 33% are reported in long-term outcome studies.
The purpose of this study was therefore to identify factors contributing to
recurrence of internal rotation gait in patients with CP who were treated with
FDO in childhood. 70 patients (age: 10 (+/- 3.3) years at surgery) with bilateral
CP and internal rotation gait were examined pre-, one year and at least five
years (mean 8 +/- 2 years) postoperatively after distal or proximal FDO, using
standardized clinical examination and 3D gait-analysis. 27 patients had a good
hip rotation one year postoperatively (between 5 degrees external and 15 degrees
internal for both limbs) and were considered for the analysis of factors
contributing to recurrence of internal rotation gait. Regarding all included
patients both mean hip rotation and foot progression angle improved significantly
(p < 0.001) from pre- to postoperative. A significant deterioration in hip
rotation (more involved side) (p < 0.001) from one year postoperatively to the
long-term follow-up can be observed. Younger age, reduced hip joint impulse,
increased plantar flexion and internal foot progression angle postoperatively
could be identified as factors for recurrence. FDO on average leads to a
satisfactory correction of internal rotation gait. In order to improve the
long-term outcome after FDO the time of multilevel surgery should be indicated as
late as possible and the different factors leading to potential recurrence should
be considered.
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