Influence of gait analysis on decision-making for lower extremity orthopaedic surgery: Baseline data from a randomized controlled trial

Abstract

Previous studies examining the influence of gait analysis on surgical decision-making have been limited by the lack of a control group. The aim of this study was to use data from a randomized controlled trial to determine the effects of gait analysis on surgical decision-making in children with cerebral palsy (CP). 178 ambulatory children with CP (110 male; age 10.3±3.8 years) being considered for lower extremity orthopaedic surgery underwent gait analysis and were randomized into one of two groups: gait report group (N=90), where the orthopaedic surgeon received the gait analysis report, and control group (N=88), where the surgeon did not receive the gait report. Data regarding specific surgeries were recorded by the treating surgeon before gait analysis, by the gait laboratory surgeon after gait analysis, and after surgery. Agreement between the treatment done and the gait analysis recommendations was compared between groups using the 2-sided Fisher's Exact test. When a procedure was planned initially and also recommended by gait analysis, it was performed more often in the gait report group (91% vs. 70%, p<0.001). When the gait laboratory recommended against a planned procedure, the plan was changed more frequently in the gait report group (48% vs. 27%, p=0.009). When the gait laboratory recommended adding a procedure, it was added more frequently in the gait report group (12% vs. 7%, p=0.037). These results provide a stronger level of evidence demonstrating that gait analysis changes treatment decision-making and also reinforces decision-making when it agrees with the surgeon's original plan.