Article

Excessive femoral anteversion is common among children with cerebral palsy, and
is, frequently treated by a femoral derotational osteotomy (FDO). It is important
to understand surgical, indications for FDO, and the impact of these indications
on the treatment outcomes.
The Random Forest algorithm was used to objectively
identify historical surgical indications in a large retrospective, cohort of 1088
limbs that had previously undergone single-event multi-level surgery. Treatment,
outcome was based on transverse plane kinematics obtained from three-dimensional
gait analysis. The, classifier effectively identified the historic indications
(accuracy = .85, sensitivity = .93, specificity = .69, positive predictive value
= .86, negative predictive value = .82), and naturally divided limbs into four,
clusters: two homogeneous +FDO clusters (with/without significant internal hip
rotation during gait), one homogeneous -FDO cluster, and a mixed cluster.
Concomitant surgeries were similar among the, clusters. Limbs with excessive
anteversion and internal hip rotation during gait had excellent outcomes, in the
transverse plane. Limbs with excessive anteversion but only mild internal hip
rotation had good, outcomes at the hip level; but a significant number of these
limbs ended up with an excessive external, foot progression angle. The Random
Forest algorithm was highly effective for identifying and, organizing historic
surgical indications. The derived criteria can be used to give surgical decision
making, guidance in a majority of limbs. The results suggest that limbs with
anteversion and significant, internal hip rotation during gait benefit from an
FDO, but limbs with excessive anteversion and only, mild internal hip rotation
are at risk of developing an excessive external foot progression angle.
CI - Copyright (c) 2013 Elsevier B.V. All rights reserved.

Langue : ANGLAIS