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Orthopedic surgery and mobility goals for children with cerebral palsy GMFCS level IV: what are we setting out to achieve?

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Background

Multilevel orthopedic surgery is considered to be the gold standard treatment for ambulatory children with cerebral palsy (CP), classified at levels I, II, or III according to the Gross Motor Function Classification System (GMFCS). Hip enlocation and stability are the main goals of orthopedic intervention in the GMFCS level IV subgroup and are well researched; however, there is no evidence to date to support or challenge the effectiveness of orthopedic treatment to preserve functional mobility in this patient group. The aim of this study was to evaluate the results of orthopedic surgery to maintain or restore standing transfers and supported walking in children with CP at GMFCS level IV.

Methods

Twenty-two children with CP GMFCS level IV who underwent orthopedic surgery to improve mobility between the years 2004 and 2008 were included in this study. A retrospective chart review was performed and a satisfaction questionnaire sent to all patients. The primary outcome measure was the attainment and maintenance of mobility goals 2 years post-surgery. The secondary outcome measures were family/patient satisfaction, Functional Mobility Scale (FMS), and complications.

Results

The two goals identified by the patients and carers were standing transfers and supported walking. At the 2-year post-surgery assessment, 14 children (63.6 %) did not reach their pre-determined goals. In the questionnaire, 21.4 % of the families reported that surgery was not beneficial. The FMS score remained unchanged in 95.4 % of the patients. Fourteen patients (63.6 %) had at least one complication that prolonged their post-operative rehabilitation (e.g., neuropraxia).

Conclusion

This study suggests that orthopedic surgery in children with CP at GMFCS level IV is unlikely to maintain or restore mobility. Furthermore, it carries a significant risk of complications.

Level of evidence

Case series, Level IV.

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Acknowledgments

We would like to acknowledge Joan Tornquist for her help in reviewing and editing the final manuscript, as well as Liz Barnes and Federica Barzi for their assistance with the statistical analysis.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Orthopaedic Department, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia

    Francesco Camara Blumetti, Jenny Chia Ning Wu, Brian Martin, Sally Anne Hobson, Matthias Wolfgang Axt & Paulo Selber

  2. Physiotherapy Department, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia

    Karen Vanessa Bau

  3. Orthopedic Department, Royal Children’s Hospital, Melbourne, VIC, Australia

    Paulo Selber

Authors
  1. Francesco Camara Blumetti
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  2. Jenny Chia Ning Wu
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  3. Karen Vanessa Bau
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  5. Sally Anne Hobson
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  6. Matthias Wolfgang Axt
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Correspondence to Francesco Camara Blumetti.

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Blumetti, F.C., Wu, J.C.N., Bau, K.V. et al. Orthopedic surgery and mobility goals for children with cerebral palsy GMFCS level IV: what are we setting out to achieve?. J Child Orthop 6, 485–490 (2012). https://doi.org/10.1007/s11832-012-0454-7

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  • DOI: https://doi.org/10.1007/s11832-012-0454-7

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