Changes in walking capacity, pain, and self-reported physical function after derotational osteotomy in adolescents with rotational deformities

Derotational osteotomy aims to alleviate pain and enhance physical functioning in adolescents with a rotational deformity of the lower extremities, but remains a topic of controversy. Therefore, this study aimed to evaluate the impact of derotational osteotomy on walking capacity, pain, and physical function in individuals with a rotational deformity of the lower extremity. Eighteen adolescents (n = 27 limbs) who underwent unilateral or bilateral derotational osteotomy of the femur and/or tibia were included in this study. The 6-minute walk test (6MWT), lower extremity functional scale (LEFS), pain over the last 24 h and the last week (numeric rating scale, (NRS)), and gait kinematics obtained during 3D gait analysis were all assessed preoperatively and 1 year after (the last) surgery. Treatment satisfaction was obtained using a visual analog scale (VAS). 6MWT distance increased by 34 m [95% CI: 9, 59] after derotational osteotomy. In addition, adolescents experienced less pain over the last 24 h (mean difference = -3.1 points [95% CI: -4.5, -1.6]) and the last week (mean difference = -2.3 points [95% CI: -4.0, -0.7]). The LEFS score improved with 14 points [95% CI: 8, 20] after derotational osteotomy. Gait kinematics showed a more neutral hip rotation and foot progression angle during the stance phase. Treatment satisfaction was high, with postoperative VAS scores of 8.5 (6.1 to 10.0). Overall, walking capacity, pain, and self-reported physical function improved after derotational osteotomy, leading to high satisfaction rates. However, because factors such as the laterality of surgery (i.e. unilateral vs. bilateral), the involved bones (i.e. femur and/or tibia), and direction of rotation (i.e. internal vs. external rotation) may differently influence treatment outcome, further research is warranted to better understand how these factors affect outcome after derotational osteotomy.