Results of treatment when orthopaedic surgeons follow gait‐analysis recommendations in children with CP

Abstract

The aim of the present study was to assess the outcome of orthopaedic surgery in ambulant children with cerebral palsy, when the orthopaedic surgeons followed the recommendations from preoperative three-dimensional gait analysis. 55 children, mean age 10y 11mo, were clinically evaluated by orthopaedic surgeons who proposed a surgical treatment plan. After gait analysis and subsequent surgery, three groups were defined. In group A, there was agreement between clinical proposals, gait-analysis recommendations, and subsequent surgery in 128 specific surgical procedures. In group B, 54 procedures were performed based on gait analysis, although these procedures had not been proposed at the clinical examination. In group C, 55 surgical procedures that had been proposed after clinical evaluation were not performed because of the gait-analysis recommendations. The children underwent follow-up gait analysis 1 to 2 years after the initial analysis. The kinematic results were satisfactory, with improvement in most of the gait parameters in children who had undergone surgery and no significant deterioration in those who were not operated. In group A, there were significant improvements in maximum hip extension in stance, minimum knee flexion in stance, timing of maximum knee flexion in swing and knee range of motion, maximum ankle dorsiflexion in stance, and mean femur rotation in stance. In group B, there were significant improvements in maximum hip extension in stance, minimum knee flexion in stance, and knee range of motion. We conclude that gait analysis was useful in confirming clinical indications for surgery, in defining indications for surgery that had not been clinically proposed, and for excluding or delaying surgery that was clinically proposed.During the past two decades, preoperative three-dimensional gait analysis has been recommended in children with cerebral palsy (CP).1,2 Previous studies have shown that it makes a substantial impact on orthopaedic decision making. 3,4 This was confirmed in our study, 5 where there was a disagreement of 51% between the proposals for surgical procedures made by the referring orthopaedic surgeons (based on clinical evaluation) and the recommendations after preoperative gait analysis. A good accordance between gait-analysis recommendations and subsequent surgery (92%) indicated that the orthopaedic surgeons followed the recommendations to a high degree. The short-term outcome of this treatment policy is studied in this paper. The study was approved by the Data Protection Officer according to the Norwegian Health Personnel Act, paragraph 26.The aim of this study was to evaluate the use of preoperative gait analysis when the orthopaedic surgeons closely followed the recommendations from the analysis. This was done by asking three questions: (1) Were the results satisfactory when there was agreement between preoperative clinical evaluation, gait analysis, and subsequent surgery? (2) Were the results satisfactory when the surgical procedures were performed based on gait analysis a...

Efficacy of clinical gait analysis: A systematic review

“…Filho et al observed a relationship between the degree to which gait analysis recommendations were followed and improvements in gait [17]. Lofterod and Terjesen reported positive kinematic outcomes in children who received surgical or non-surgical treatment consistent with gait analysis recommendations [18]. Molenaers et al found that patients managed with gait analysis had a lower prevalence of surgery at all ages and a lower rate of multiple surgeries than historical controls managed without gait analysis [19].…”

Barriers and Facilitators to Using Knee Gait Analysis Report Findings in Physiotherapy Practice

“…Gait analysis can be used to gain a better understanding of the causes and consequences of certain movement disorders. It also provides clinicians an opportunity to measure the effect of interventions aimed at restoring joint function and improving the performance of walking such as surgery [1], physical therapy [2] or pharmacological treatment [3].…”

“…Although Wren et al [8] admit that further high-quality studies, such as randomized controlled trials, are needed to ascertain the efficacy of gait analysis in improving a patient's condition, there are a few studies of interest. One such example is the study conducted by Lofterod et al [1]. This study demonstrated that an orthopedic surgical approach selected as a result of pre-operative gait analysis findings lead to better functional recovery compared to an approach chosen solely based on clinical assessment data.…”

A WEARABLE GAIT ANALYSIS SYSTEM USING INERTIAL SENSORS PART I - Evaluation of Measures of Gait Symmetry and Normality against 3D Kinematic Data

“…As a result of not undergoing GA, many patients may receive sub-optimal treatment, e.g. (Kay et al, 2000), (Lofterød and Terjesen, 2008).…”