Background: Only a few studies have investigated the change in energy cost and functional ability after lower limb bone surgeries in children with cerebral palsy (CP).

Research Objectives: To examine the effect of intervention (surgery) in the operated group over time on: Energy cost values, Walking functions, and on Functional mobility.

Setting: Motion analysis laboratory and the child development and rehabilitation center at Assaf Harofeh Medical Center.

Methods: Participants in the study consisted of 41 children with CP. The study consisted of two groups: one that had undergone surgery (the operated group) and a control group. The operated group consisted of 20 children with CP who were candidates for Femoral Derotation Osteotomy (FDO) or Tibial Derotation Osteotomy (TDO), or both. They were examined three times: the first was one day prior to surgery; the second was six months after surgery; and the third was about a year after surgery. Each examination included: anthropometric measurements, energy cost measurement using the Heart beat cost index (HBCI) in the stair climbing test, assessment of function during walking using the Functional assessement questionnaire (FAQ) and assessment of motor function using the Gross motor functional classification system (GMFCS). Control group consisted of 21 children with CP in ages compatible to the operated group, who had not been operated during the passing year. The control group was examined two times, the second a year after the first. The examination was the same as in the operated group.

Main Results: In the operated group, a significant change (p< 0.0076) was observed in energy cost values over time following surgical intervention. The change was indicated in decreasing energy cost values from measurement to measurement (from value of 0.91 to value of 0.48). Significant decrease was found in the third measurement, as compared to the first measurement (p=0.0026). In the control group, a decrease, although not significant (p=0.062) was observed in energy cost values. Angles values measured in both hip and tibia a year after surgery were changed significantly (p< 0.004). Angles values after surgery were measured within normal range.

Conclusions: This study indicates that the FDO and TRO have effected over time on the energy cost values in the operated group.

Aim: To evaluate the long term effect of Distal transfer of the greater trochanter in Perthes’ disease.

Patients and methods: Twelve patients (thirteen hip joints, 10 males and 2 females) who suffered from Perthes’ Disease were treated by distal transfer of the greater trochanter (DTT). The operation was performed because of progressive shortening of the articulo-trochanteric distance accompanied by signs of insufficiency of the hip abductors. Total or near total femoral head involvement was found in all the patients except for one of them. Follow up period was 28 years (21–35). Mean age at diagnosis of Perthes’ was 7 years (4–11). Patient were studied in 1992 and reviewed again 13 years later, using the Harris hip score, short form 36 (SF36), physical examination and A-P X-rays.

Results: Not one of the patients underwent a total hip arthroplasty. Mean Harris hip score is 80 (range 54–100, 4 patients under 70 score). Mean SF36 score was 71 (range 30–94) and was correlated to the Harris score. Three of the patients were working in a physically demanding profession. The rest were office workers. Two of them chose non strenuous type of work due to the hip condition. Limb length discrepancy was 1.7 cm short on the operated side (range 0–3) and correlated with Trendelenburg sign (4 patients with positive sign). Femoral head sphericity according to Stulberg classification was good in 5 patients (grades 1–2), fair in 3 patients (grade 3) and poor in 4 patients (grade 4–5). Head sphericity was not correlated to age at diagnosis, Harris score, SF36 score or level of hip pain.

Conclusions: Long term outcome are surprisingly good in those patients, considering the degree of head involvement, advanced age at diagnosis and severity of disease which necessitated high degree of varus osteotomy and hence trochanter transfer.

This study reviews our 13-years experience with Haas’s multiple-longitudinal osteotomy technique for correction of tibial deformities in children. In this procedure multiple longitudinal bi-cortical osteotomies are made parallel in the proximal tibia. The deformity is corrected by applying moderate force in the desired plane. Fixation is achieved with either a long cast or with “pins-in-plaster”.

Sixty osteotomies were performed in 37 children. Thirty-five cases had internal tibial torsion (ITT), 11 had external tibial torsion (ETT) and 14 had a Tibia Vara deformity. Twenty-one cases had Spastic Cerebral Palsy and 15 cases were associated with Clubfeet. One boy had bilateral tibia vara associated with SMED (Spondylo-meta-epiphyseal dysplasia). Twenty-two (36/7%) of the deformities had no underlying musculoskeletal conditions.

Thigh-foot angles were corrected by a mean of 24^° for ITT and −28° for ETT. Mean correction for tibia vara was 20°. Average anesthesia time for unilateral cases was 47 minutes. No neurologic or infectious complications, postoperative fractures or physeal damage occurred. There was one case of delayed union and 1 case of postoperative antecurvatum deformity. All 7 cases of postoperative recurrent deformities were associated with CP or SMED.

This technique is a simple, safe and efficient method for correcting tibial torsional and varus deformities for both healthy children and those with underlying conditions. It allows accurate alignment of different deformities with an uniform osteotomy technique, which preserves bone continuity and provides inherent stability, thus avoiding the use of internal fixation.