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Rotationplasty did not improve function in patients with proximal femoral focal deficiency
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Results presented at the Limb Lengthening and Reconstruction Society Annual Scientific Meeting showed Van Nes rotationplasty for treatment of proximal femoral focal deficiency provided no functional improvement or patient-reported benefits compared with other prosthetic treatment options.
“A common belief is that performing rotationplasty to preserve the ankle joint for function as a knee joint improves gait and overall outcome, but we found this was not the case,” Lorena Floccari, MD, co-author of the study, told Healio.com/Orthopedics. “In [proximal femoral focal deficiency] PFFD, rotationplasty provides no functional improvement of patient-reported benefit over other prosthetic treatment options.”
Floccari and colleagues performed gait analysis and recorded proximal femoral focal deficiency classification, prior surgeries and the status of the hip and knee joints for 19 patients with unilateral proximal femoral focal deficiency. Included in this group were six patients with an equinus prosthesis, six patients with a Van Nes rotationplasty and seven patients with a Syme amputation and above-knee prosthesis. Researchers also measured kinematic values, including pelvis tilt, hip range of motion, hip power, abductor impulse, cadence parameters and the gait deviation index. Oxygen consumption and VO2 cost were measured during ambulation, and patient-reported outcomes were measured using the pediatric outcomes data collection instrumentation.
Results showed patients in the Van Nes rotationplasty group underwent more mean surgeries vs. the Syme amputation and equinus prostheses groups. Although patients in the equinus prostheses group walked faster than patients the Van Nes rotationplasty group, researchers found no significant differences between the Van Nes rotationplasty and Syme amputation groups.
“There were no differences between groups in pelvic tilt, hip flexion/extension or abductor impulse, although all groups were significantly below normal ranges,” Floccari said.
Patients in the Syme amputation group had improved kinematics, as well as greater hip power at foot off compared with the other groups.
“The rotationplasty group actually absorbed power at foot off rather than generating it, a finding that was independent from walking speed,” Floccari said.
She added the groups had no differences in oxygen consumption, “with all children requiring greater energy expenditure than normal children.” In terms of pain, sport/physical function, happiness and global function, results showed no significant differences between groups.
“Transfer/basic mobility improves with age (as children improve their ability to walk with the prosthesis over time), but we identified no other correlations between classification, treatment, gait outcome variables or patient-reported outcome scores,” Floccari said. – by Casey Tingle
Reference:
Floccari L, et al. Gait analysis in children with proximal femoral focal deficiency. Presented at: Limb Lengthening and Reconstruction Society Annual Scientific Meeting; July 13-14, 2018; San Francisco.
Disclosure: Floccari reports no relevant financial disclosures.