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
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.