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The Effects of Quantitative Gait Assessment and Botulinum Toxin A on Musculoskeletal Surgery in Children with Cerebral Palsy

Molenaers, Guy MD, PhD; Desloovere, Kaat PhD; Fabry, Guy MD, PhD; De Cock, Paul MD, PhD

Journal of Bone & Joint Surgery - American Volume: January 2006 - Volume 88 - Issue 1 - p 161–170
doi: 10.2106/JBJS.C.01497
Scientific Articles

Background: The limits of nonoperative treatment for children with cerebral palsy, including physical therapy and orthotics, commonly lead to orthopaedic surgical intervention. The purpose of the present study was to evaluate the influence of gait analysis and botulinum toxin type-A injections on the timing, prevalence, and frequency of orthopaedic surgery.

Methods: We performed a retrospective review of 424 children with cerebral palsy who had been born between 1976 and 1994. The children were divided into three groups: Group 1 comprised 122 patients who were managed throughout the entire study period according to best-practice guidelines in orthopaedics, Group 2 comprised 170 patients who were similarly managed but with input from gait analysis, and Group 3 comprised 132 patients who had gait analysis and also received botulinum toxin type-A injections. We analyzed the prevalence of orthopaedic surgical procedures at different ages (three to nine years) and the time to the first surgical procedure.

Results: The progression to orthopaedic surgery was significantly different among the three groups (p < 0.0001). The proportion of patients who had undergone at least one surgical procedure by the age of seven years was 52% (sixty-four of 122) for Group 1, 27% (forty-six of 170) for Group 2, and 10% (thirteen of 132) for Group 3. There was a delay in surgery in Group 2 as compared with Group 1 (p < 0.00001 at seven, eight, and nine years of age) and a significant decrease in the prevalence of orthopaedic surgical procedures for Group 3 as compared with Group 1 (p < 0.00001 at four to eight years of age) and Group 2 (p < 0.0025 at four to nine years of age).

Conclusions: In the treatment of children who have cerebral palsy, the introduction of gait analysis increases the age of the first orthopaedic surgical procedure and botulinum toxin type-A treatment delays and reduces the frequency of surgical procedures.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

1 Department of Pediatric Orthopaedics, University Hospital Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium. E-mail address for G. Molenaers:

2 Gait Analysis Laboratory CERM and Department of Rehabilitation Sciences, University Hospital Pellenberg and Katholieke Universiteit Leuven, Weligerveld 1, 3212 Pellenberg, Belgium

3 Department of Neuro-pediatrics, University Hospital of Leuven, Gasthuisberg, Herestraat 1, 3000 Leuven, Belgium

Copyright 2006 by The Journal of Bone and Joint Surgery, Incorporated
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