Article

Excessive femoral anteversion is common in cerebral palsy (CP), is
often associated with internal hip rotation during gait, and is frequently
treated with a femoral derotational osteotomy (FDO). Concerns exist regarding
long-term maintenance of surgical outcomes. Past studies report varying rates of
recurrence, but none have employed a control group. METHODS: We conducted a
retrospective analysis examining long-term (approximately 5 years) changes in
anteversion and hip rotation following FDO in children with CP. We included a
control group that was matched for age and exhibited excessive anteversion (>30
degrees ) but did not undergo an FDO. Anteversion, mean stance hip rotation, and
rates of problematic remodeling and recurrence were assessed
(>15 degrees change
and final level outside of normal limits). RESULTS:
The control group was
reasonably well matched, but exhibited 9 degrees less anteversion and 3 degrees
less internal hip rotation at the pre time point. At a five year follow-up, the
FDO group had less anteversion than the control group (20 degrees vs. 35 degrees
, p<0.05). The mean stance phase hip rotation did not differ between the groups
(4 degrees vs. 5 degrees , p=0.17). Over one third of limbs remained excessively
internal in both groups (FDO: 34%, Control: 37%). Rates of problematic recurrence
and remodeling were low (0%-11%). CONCLUSIONS:
An FDO is an effective way to
correct anteversion in children with CP. Long-term hip rotation is not fully
corrected by the procedure,
and is not superior to a reasonably well matched
control group. Rates of problematic recurrence and remodeling are low, and do not
differ between the groups.
CI - Copyright (c) 2016 Elsevier B.V. All rights reserved.

Langue : ANGLAIS