Child/Adolescent Health

Children with cerebral palsy who undergo gait assessment before surgery are less likely to need additional surgery later

Children with cerebral palsy who have problems walking often undergo several rounds of surgery to correct their gait. If they have clinical gait analysis (GA) before their initial corrective surgery, they are less likely to need additional orthopedic surgery later, according to a new study. This reduction in future surgeries means less disruption in the children's lives in later years. GA assesses a child's multiple joints in multiple planes of motion to better identify the causes of gait problems, so that the orthopedic surgeon can intervene at multiple levels to correct them during the initial surgery.

After adjusting for differences in age and severity of functional problems between the 313 children who received GA and the 149 children who received no GA (NGA) before their initial surgery, the GA children had more distinct procedures during the initial surgery than did the NGA children (5.8 vs. 4.2). However, only 11 percent of the GA children needed additional surgery in contrast to 32 percent of the NGA children. The cost of the initial surgical session was higher for the GA children than those in the NGA group (mean of $43,006 vs. $35,215). However, the additional cost per person-year was $916 for the GA group versus $3,009 for the NGA children. This led to a nonsignificant difference in total cost per person-year ($20,448 vs. $19,535).

The researchers acquired their data by a retrospective review of all ambulatory patients with cerebral palsy who underwent orthopedic hip, leg, or foot surgery to correct their gait at the Children's Hospital of Los Angeles between 1991 and 2005. Only patients with at least a 6-month followup were included. Because the study was retrospective, it was not able to look at outcomes such as functional improvement, participation in activities, and quality of life. The study was funded in part by the Agency for Healthcare Research and Quality (HS14169).

More details are in "Effect of pre-operative gait analysis on costs and amount of surgery," by Tishya A.L. Wren, Ph.D., Michael M. Kalisvaart, M.D., Christine E. Ghatan, B.S., B.A., and others in the September 2009 Journal of Pediatric Orthopaedics 29(6), pp. 558-563.

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