Changes in pelvic rotation after soft tissue and bony surgery in ambulatory children with cerebral palsy

The authors performed a retrospective review of pelvic rotation in 59 children with cerebral palsy who underwent lower extremity surgery and pre- and postoperative gait analysis. Two groups were studied: a femoral derotation osteotomy (FDRO) group and a soft tissue surgery only (no FDRO) group. Both groups exhibited abnormal pelvic rotation preoperatively and normalization of this abnormal pelvic rotation postoperatively. Though the mean change in pelvic rotation was small (3.3degrees +/- 6.0degrees), some patients demonstrated postoperative changes as large as 21degrees. Variability in pelvic rotation was greater in the no FDRO group than in the FDRO group. Improvement in pelvic rotation occurred both in children with unilateral (hemiplegic) involvement and in those with bilateral (diplegic or quadriplegic) involvement. Surgeons planning lower extremity surgery in children with cerebral palsy should expect improvement in abnormal pelvic rotation in both hemiplegic and diplegic patients, whether or not bony surgery is planned in addition to soft tissue surgery.