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

Long-term outcomes of the multilevel surgical approach in children with cerebral palsy

S OUNPUU MSC, S E ADOLFSEN MD, K J BELL MS, P A DELUCA MD

  1. 1. Center for Motion Analysis, Connecticut Children’s Medical Center, Hartford, CT, USA

Objectives: To investigate the long-term gait outcomes of a specific multilevel surgical package using three-dimensional kinematics and kinetics.

Design: Retrospective non-randomized evaluation.

Participants/Setting: Thirty-one children with a diagnosis of cerebral palsy (CP) were included in this study. Inclusion criteria included pre- and postoperative motion analysis, joint kinetics, and the following procedures in all patients: hamstring lengthening, rectus femoris transfer, and gastrocnemius lengthening. Exclusion criteria included bony or intervening surgical intervention. All data were collected at a tertiary referral center that specializes in the treatment of children with CP.

Methods: All patients underwent a three-dimensional motion analysis following standard techniques 1 as part of clinical care. A Student’s paired t-test was used to make pre to post comparisons.

Results: A subset of nine children (12 sides) all with a crouch gait pattern pre-surgery had long-term gait assessments. The mean age at the preoperative gait analysis was 7 year 10 months (SD 1y), at surgery was 8 years (SD 1y) and at long-term postoperative gait analysis was 12 years 7 months (SD 1y) for a mean follow-up of 4 years 7 months (SD 1y). Gait changes (or trends) attributable to the medial hamstring lengthening, included improvement in mean knee angle at initial contact (35 0 [SD 7 0] pre to 25 0 [SD 10 0] post, p<0.004), mean knee angle in stance (28 0 [SD 50] pre to 21 0 [SD 14 0] post, p<0.05) and mean knee extensor moment in stance (0.23 [SD 0.13] N.m/kg pre to 0.12 [SD 0.23] N.m/kg post, p<0.09). Gait changes related to the rectus femoris transfer showed a reduction in comparison to typical values of the mean peak flexion in seing (58 0[SD 10 0] pre to 50 0 [SD 9 0] post, p<0.04), however, the timing of peak knee flexion in swing was improved (80 [SD 5] % GC pre to 75 [SD 3] % GC post, p<0.01). Gait changes related to the gastrocnemius lengthening showed improvements in timing of mean peak dorsiflexion in stance (16[SD9] % GC pre to 40 [SD 12] % GC post, p<0.01). The mean peak dorsiflexion and power generation in stance remained unchanged and within the normal range.

Conclusions/Significance: This study demonstrated that many of the functional gait benefits of this particular combination of surgeries can be documented 5 years post intervention. Considering that the natural progression of gait in these patients is to decline, 2. treatments that not only improve but maintain function overtime provide benefit.

References

  1. 1. Davis RB, DeLuca PA. (1996) Clinical Gait Analysis: Current Methods and Future Directions. Piscataway: IEEE Press,p17-42.
  2. 2. Bell K, Ounpuu S, DeLuca PA, Romness MJ. (2002) Natural progression of gait in children with cerebral palsy. J Pediatr Orthop 22: 677-682.
 
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