Pain and rehabilitation problems after single-event multilevel surgery including bony foot surgery in cerebral palsy

Figures & data

Table 1. Description of the cohort of 70 SEMLS patients from which the patients were selected

Diagnoses
Unilateral cerebral palsy	4
Bilateral cerebral palsy	64
Other diagnoses	2
GMFCS level
Level 1	4
Level 2	39
Level 3	27
Surgical procedures, total = 399
Psoas tenotomies	73
Adductor tenotomies	39
Rectus femoris transfers	91
Hamstrings tenotomies	94
Gastrochnemius slides	40
Achilles lengthenings	15
Various surgeries	6
Proximal femoral osteotomies	23
Dega acetabuloplasties	2
Bony foot surgeries	15

Table 2. Surgeries performed on the patients

Patient	Sex	Age at SEMLS	Surgeries performed prior to SEMLS	Surgeries at SEMLS ^a	Foot corrections at SEMLS ^a
1	Female	10	None	Psoastenotomies over the brimRectus femoris transfers to gracilisMedial hamstring lengtheningsGastrocnemius recessions	Grice extra-articular arthrodeses
2	Male	15	Medial hamstring lengthening	IleopsoastenotomiesAdductor tenotomiesRectus femoris transfers to gracilisMedial hamstring lengthenings (second time)	Triple arthrodeses
3	Female	14	Adductor tenotomiesIleopsoas tenotomiesMedial hamstrings lengtheningsGastrocnemius recessions	Psoastenotomies over the brimAdductor tenotomy right side (second time)Rectus femoris transfers to gracilisMedial hamstring lengthening (second time)	Calcaneal lengthening oste-otomies
4	Male	16	Tendon achilles lengtheningsMedial hamstring lengthening	Psoastenotomies over the brimRectus femoris transfers to gracilisMedial hamstring lengthenings (second time)Gastrocnemius recessions	Triple arthrodeses
5	Female	10	Proximal femoral derotational osteotomy, left side	Psoastenotomies over the brimRectus femoris transfers to gracilisMedial and lateral hamstring lengtheningsGastrocnemius recessions	Calcaneal lengthening osteotomy, right foot
6	Male	9	Adductor tenotomiesIleopsoas tenotomiesMedial hamstring lengthening	Rectus femoris transfers to gracilisMedial hamstring lengthening, right sideGastrocnemius recessions	Calcaneal lengthening oste-otomies
7	Male	10	Medial hamstring lengthening Tendon achilles lengthening	Psoastenotomies over the brimRectus femoris transfers to gracilisMedial hamstring lengthenings	Grice extra-articular arthrodesis, right foot

^a Bilateral procedures unless noted otherwise

Table 3. Comparison of preoperative and postoperative gait parameters

	Pre-operatively mean (SD)	Post-operatively mean (SD)	p-value (t-test)
In stance (°)
Maximum ankle dorsiflexion	15 (7)	19 (7)	0.1
Mean foot progression	–8 (17)	–12 (10)	0.4
Minimum knee flexion	37 (16)	29 (15)	0.001
Maximum hip extension	15 (9)	18 (13)	0.2
Mean femur rotation	2 (3)	3 (4)	0.4
Mean anterior pelvic tilt (°)	10 (10)	6 (5)	0.08
Cadence (strides/min)	111 (29)	95 (26)	0.4
Stride length (cm)	76 (18)	65 (24)	0.2
Velocity (cm/s)	70 (23)	53 (28)	0.1

Table 4. FMS evaluated at gait analysis preoperatively and 1 year postoperatively

	Preoperatively				1 year postoperatively
	Min	Max	Mean	SD	Min	Max	Mean	SD
FMS preop 5 m	2	5	4.2	1.2	3	5	4.2	1
FMS preop 50 m	2	5	3.5	1.4	3	5	3.5	0.8
FMS preop 500 m	1	4	1.8	1.3	1	4	1.5	1.2