SynthesisBrazilian journal of physical therapy
Impact of femoral derotation osteotomy on gait in ambulatory children with cerebral palsy: A systematic review and meta-analysis.
Synthesis in Brazilian journal of physical therapy. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
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Authors and funding
7 authors.
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Abstract
backgroundFemoral derotation osteotomies (FDRO) are commonly performed in children with cerebral palsy who present with intoeing gait. However, the impact of FDRO on gait function and long-term results remains unclear.
objectiveThis study aimed to quantify and qualify gait changes following gait-improving surgeries involving FDRO in ambulatory children with cerebral palsy and no associated hip pathologies, to support individualized decision-making regarding this invasive procedure.
methodsA systematic search was conducted in May 2023 across six databases. Kinetic, kinematic, temporospatial parameters, and gait scores were extracted pre- and post-FDRO. A random-effects meta-analysis was performed.
resultsForty-six articles, including 1144 patients, were analyzed. Significant improvements were observed in pelvic rotation (mean change: 6.6°, 95 % confidence interval [CI]: 2.2 to 11), hip rotation (mean change:14.4°, 95 % CI:16.7 to -12.1), foot progression angle (mean change:16.1°, 95 % CI:18.3 to -14), and gait scores (standardized mean difference [SMD]: 0.99, 95 % CI: 0.52 to 1.47). The estimated improvement in gait scores corresponded to a 10-point increase in the Gait Deviation Index in the short term and 6.9 points in the long term. No deterioration was found in any assessed parameter. Intoeing gait was corrected in 74 % of patients at one year and in 69 % at five years postoperatively. The recurrence rate was 13 %.
conclusionWhile evidence suggests that femoral derotation osteotomies in ambulatory children with cerebral palsy without hip pathology improve overall gait function, the quality of available data is low. Patient-reported outcomes, including quality of life and satisfaction, are lacking. Definitive surgical indication could not be established; factors to consider include femoral anteversion, hip rotation at gait analysis, patient age, and relevant functional impairments.
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