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Aschau am Inn, Germany

Bohm H.,Orthopaedic Hospital for Children | Hagemeyer D.,Wolfart Clinic Grafelfing | Thummerer Y.,Social pediatric center in Munich | Kipping R.,Wolfart Clinic Grafelfing | And 2 more authors.
Gait and Posture | Year: 2016

The minimal invasive anterolateral Yale 2-incision approach for total hip arthroplasty aims minimizing damage to the muscles for faster recovery of function. Therefore the hypothesis was investigated, that during the rehabilitation process the Yale approach shows a faster return to natural gait than a conventional lateral approach. Nineteen patients had the Yale, 16 the conventional Bauer approach. Instrumented gait analysis was performed 3 days, 3 and 12 month post operatively. Velocity, cadence, step length, weight bearing, thorax lean, Trendelenburg limp, hip abduction moments, and hip muscle activation times were evaluated. Three days post-surgery a significantly greater loading of the treated limb and increased hip abduction moment were observed in the Yale group. In addition, the Yale group showed its greatest improvement in walking speed and step length between at 3 days and 3 months, whereas the conventional group showed an additional significant gain between 3 and 12 month to reach a similar walking speed as the Yale group. For all hip muscles investigated, only muscle tensor fasciae latae in the conventional group showed a significant increase in activation time between 3 days and 3 months. This study showed significantly faster return to natural gait in the Yale compared to the conventional approach, which could be biomechanically related to less impairment of abductor muscles in the Yale approach. © 2015 Elsevier B.V. Source

Dreher T.,University of Heidelberg | Wolf S.I.,University of Heidelberg | Heitzmann D.,University of Heidelberg | Swartman B.,University of Heidelberg | And 5 more authors.
Gait and Posture | Year: 2012

Satisfactory short-term results after femoral derotation osteotomy (FDO) for the treatment of internal rotation gait in cerebral palsy have been reported by various authors. However, there are only a few longer-term studies reporting results 5. years after FDO and these are not in agreement. There are no reports on the clinical course beyond the pubertal growth spurt. 33 children with diplegia (n=. 59 legs, age: 10.5. ±. 3.6. years) and internally rotated gait were examined pre- (E0), 1. year (E1), 3. ±. 1 (E2) and 9. ±. 2 (E3). years after distal (27 legs) or proximal (32 legs) FDO as part of multilevel surgery, using standardized clinical exam and 3D gait-analysis at all examinations. The amount of intra-operative derotation averaged 25°. ANOVA was used for statistics (p<. 0.05). Mean hip internal rotation in stance at E0 of 17.3° was significantly changed to 1.0° of external rotation at E1 and was maintained at 4.2° at E3. The same clinical course was found for foot progression angle. The mid-point of passive hip rotation at E0 was 21°. This was significantly decreased to 6° at E1 and showed a small but significant increase reaching 12° at E3. The results of this study showed a good overall correction of internally rotated gait following FDO. These improvements were maintained at long-term follow-up after the pubertal growth spurt. Recurrence was observed in some cases with overall severe deterioration. In those patients persistent dynamic factors leading to recurrence should be further investigated. © 2012 Elsevier B.V. Source

Niklasch M.,University of Heidelberg | Wolf S.I.,University of Heidelberg | Klotz M.C.,University of Heidelberg | Geisbusch A.,University of Heidelberg | And 3 more authors.
Gait and Posture | Year: 2015

Femoral derotation osteotomy (FDO) as gold standard treatment for internal rotation gait in cerebral palsy (CP) leads to satisfying short-term results, whereas rates of recurrence up to 33% are reported in long-term outcome studies. The purpose of this study was therefore to identify factors contributing to recurrence of internal rotation gait in patients with CP who were treated with FDO in childhood.70 patients (age: 10 (±3.3) years at surgery) with bilateral CP and internal rotation gait were examined pre-, one year and at least five years (mean 8 ± 2 years) postoperatively after distal or proximal FDO, using standardized clinical examination and 3D gait-analysis. 27 patients had a good hip rotation one year postoperatively (between 5° external and 15° internal for both limbs) and were considered for the analysis of factors contributing to recurrence of internal rotation gait.Regarding all included patients both mean hip rotation and foot progression angle improved significantly (p<. 0.001) from pre- to postoperative. A significant deterioration in hip rotation (more involved side) (p<. 0.001) from one year postoperatively to the long-term follow-up can be observed. Younger age, reduced hip joint impulse, increased plantar flexion and internal foot progression angle postoperatively could be identified as factors for recurrence.FDO on average leads to a satisfactory correction of internal rotation gait. In order to improve the long-term outcome after FDO the time of multilevel surgery should be indicated as late as possible and the different factors leading to potential recurrence should be considered. © 2015 Elsevier B.V. Source

Bohm H.,Orthopaedic Hospital for Children | Stief F.,Orthopedic University Hospital Friedrichsheim gGmbH | Sander K.,Friedrich - Schiller University of Jena | Hosl M.,Orthopaedic Hospital for Children | Doderlein L.,Orthopaedic Hospital for Children
Gait and Posture | Year: 2015

Malaligned knees are predisposed to the development and progression of unicompartmental degenerations because of the excessive load placed on one side of the knee. Therefore, guided growth in skeletally immature patients is recommended. Indication for correction of varus/valgus deformities are based on static weight bearing radiographs. However, the dynamic knee abduction moment during walking showed only a weak correlation to malalignment determined by static radiographs. Therefore, the aim of the study was to measure the effects of guided growth on the normalization of frontal plane knee joint moments during walking.15 legs of 8 patients (11-15 years) with idiopathic axial varus or valgus malalignment were analyzed. 16 typically developed peers served as controls. Instrumented gait analysis and clinical assessment were performed the day before implantation and explantation of eight-plates. Correlation between static mechanical tibiofemoral axis angle (MAA) and dynamic frontal plane knee joint moments and their change by guided growth were performed.The changes in dynamic knee moment in the frontal plane following guided growth showed high and significant correlation to the changes in static MAA (R= 0.97, p< 0.001). Contrary to the correlation of the changes, there was no correlation between static and dynamic measures in both sessions. In consequence two patients that had a natural knee moment before treatment showed a more pathological one after treatment.In conclusion, the changes in the dynamic load situation during walking can be predicted from the changes in static alignment. If pre-surgical gait analysis reveals a natural load situation, despite a static varus or valgus deformity, the intervention must be critically discussed. © 2015 Elsevier B.V. Source

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