Article

Internal rotation gait is common among children with bilateral cerebral palsy.
However, despite bilaterally increased femoral anteversion asymmetric internal
rotation gait is often found. Femoral derotation osteotomy (FDO) is commonly
performed bilaterally. Variable functional outcomes are reported especially in
cases with mild internal hip rotation during gait and abnormal preoperative
pelvic rotation. A major question is if a unilateral treatment of the more
involved side in asymmetric cases leads to a comparable or even superior outcome.
One hundred and nine children with spastic bilateral CP treated with FDO with
pre- and 1-year postoperative 3D gait analysis were retrospectively collected.
The asymmetry was calculated from the preoperative difference between both limbs
in hip rotation obtained by 3D gait analysis. Twenty-eight children with
asymmetry larger than 20 degrees were selected and classified into two groups,
according to whether they obtained a unilateral or bilateral FDO. Preoperative
clinical examination and pre- and postoperative hip and pelvic rotation in gait
analysis on the more and the less involved side did not differ significantly
between both groups. Interestingly, in both groups, hip rotation did not change
significantly in less-involved limbs, although intraoperative derotation averaged
25 degrees . After unilateral FDO a significant change in pelvic rotation
resulted, whereas this was not found after bilateral FDO. The results of this
study suggest that unilateral FDO in children with asymmetric internal rotation
gait leads to a comparable functional outcome compared to bilateral treatment.
Furthermore, it was shown for the first time that considering the asymmetry has a
positive effect on pelvic rotation.
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Langue : ANGLAIS