Researcher(s)
- Yusra Adlani, Human Physiology, University of Delaware
Faculty Mentor(s)
- Chris Church, Orthopedics, Nemours Children's Hospital
- Arianna Trionfo, Orthopedics, Nemours Children's Hospital
Abstract
Background
Femoral anteversion and tibial torsion are common bony malrotations in youth with cerebral palsy (CP). Femoral derotational osteotomies (FDOs) and tibial derotational osteotomies (TDOs) are safe procedures that correct them, but postoperative protocols vary. Prolonged non-weight bearing (NWB) may delay recovery, whereas immediate weight bearing (WB) could accelerate rehabilitation. This study compared complication rates between WB and NWB protocols.
Methods
In this IRB-approved retrospective cohort, ambulatory youth with CP (Gross Motor Function Classification System I-III) who underwent ≥ 1 FDO or TDO, and completed both pre- and postoperative gait analyses, were reviewed. Complications were grouped as: short term (≤6 months: delayed bone union, hardware failure, or infection requiring return to the operating room); mid-term (1-3 years: rotational correction on gait analysis); and long-term (>3 years: recurrence requiring revision surgery). Fisher’s exact tests compared complication rates between WB and NWB groups; multivariate analysis identified predictors of recurrence.
Results
188 youth (284 limbs) underwent 333 osteotomies (180 FDO, 153 TDO) at mean age 11.9 ± 3.5 years. 89% were immediately WB, and 11% NWB. Acute complications were rare and similar between both groups (all p≥0.9). Mid-term correction did not differ for FDO (71.8% WB vs 64.7% NWB, p=0.74) or TDO (72.0% WB vs 90.5% NWB, p=0.12). Higher pre-operative GMFM-D scores predicted fewer recurrences (p=0.02); WB status did not (p=0.73)
Conclusion
Immediate WB after FDO or TDO does not increase short-term complications, impact correction, or raise the risk of long-term recurrence, supporting its use to accelerate rehabilitation without added risk.