Influence of gait analysis on decision-marketing for lower extremity surgery

Distal femoral osteotomy and patellar tendon advancement in the treatment of crouch gait: a review of complications

TOM F NOVACHECK MD A,B, JEAN STOUT MS PT A, JAMES GAGE MD A,B

  1. 1. Gillette Children’s Speciality Healthcare, St Paul;
  2. 2. University of Minnesota, Department Orthopaedic Surgery, Minneapolis, MN, USA

Objective: To examine the type and rate of complications associated with distal femoral extension osteotomy (DFEO) and patellar tendon advancement (PTA) procedures, to assist in counseling families regarding the risks of intervention.

Design: A retrospective case series medical record review.

Setting: A regional referral center for children and adults with disabilities.

Participants: All individuals who underwent either DFEO, PTA, or a combination of the two procedures between the first procedure performed in 1994 and July 1, 2005. A minimum follow-up time of 6 months was required to be included in the study.

Method: Institutional Review Board approval was obtained for this retrospective medical record review. Data from the surgical admission to the last available clinic note were reviewed for each patient. Any unwanted event was considered a complication. Short-term complications relating to initial in-patient stay or casting were not considered as part of this analysis. Complication types and rates were recorded separately for each procedure in a consecutive manner.

Results: One hundred and seventy-one individuals who had undergone one or both procedures were identified. A total of 205 surgical events were reviewed with 198 DFEO and 249 PTA procedures performed. Sixty-seven patients were female, 104 were male; mean age was 15 years 1 month (SD 4y 11mo; range 4y 7mo-39y). The distribution of patients by age was skewed, with the majority of individuals aged between 10 and 20 years. The majority of procedures were performed between 2000 and 2005 (88% DFEO; 90% PTA). Eighty-five percent of the patients had a primary diagnosis of cerebral palsy. No single diagnosis in the remaining 15% had a frequency greater than 3% of the total.
Total complication rate for DFEO was 14% (28/198) and the complication rate for PTA was 24% (59/249; Table C:6). Stretch palsy and neuropathy accounted for the largest percentage of complications in the DFEO series. Fixation failures accounted for the largest percentage in the PTA series (Fig. C:6). Changes in surgical technique and postoperative management occurred with experience. A stabilization of complications was noted for DFEO after the first 40 procedures. The PTA complications demonstrated a more gradual decline. With modification of surgical techniques fixation failures were reduced from the most frequent complication to one of the most infrequent complications in the PTA series.

Conclusions: The most common complications were different between the two procedures. The complication rate of the PTA is higher than that of DFEO. The stabilization of complications with time demonstrates a definite learning curve for each procedure. Although complications can and do occur, with experience, they can be anticipated, managed, and avoided.

 
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