The 5-Year Outcome of the Ponseti Method in Children With Idiopathic Clubfoot and Arthrogryposis.

BACKGROUND: The Ponseti method effectively treats idiopathic clubfoot, but its effectiveness in treating the stiffer clubfoot associated with arthrogryposis is less clear. The purpose of this study was to assess the comparative effectiveness of the Ponseti method in 5-year-old children with either idiopathic clubfoot or clubfoot due to arthrogryposis. METHODS: The outcomes of the Ponseti method were retrospectively evaluated in children with idiopathic clubfoot and clubfoot associated with arthrogryposis. The children with clubfoot were seen at our hospital between 2012 and 2019 and were 4.0 to 6.9 years old at the time of their evaluation. Outcomes of the 2 groups of children with clubfoot were assessed using passive range of motion, foot pressure analysis, the Gross Motor Function Measure Dimension-D, and parent report using the Pediatric Outcomes Data Collection Instrument. These results were also compared with the same measures from a group of typically developing children. Surgical and bracing history was also recorded. RESULTS: A total of 117 children were included (89 idiopathic clubfoot and 28 associated with arthrogryposis) with an average age of 4.8±0.8 years. The historical gait analyses of 72 typically developing children were used as a control, with an average age of 5.2±0.8 years. Significant residual equinovarus was seen in both children with idiopathic clubfoot and associated with arthrogryposis according to passive range of motion and foot pressure analysis when compared with normative data. Children with arthrogryposis demonstrated limited transfer and basic mobility, sports functioning, and global functioning while children with idiopathic clubfoot were significantly different from their typically developing peers in only transfer and basic mobility. CONCLUSIONS: Although children with idiopathic clubfoot continue with some level of residual deformity, the Ponseti method is effective in creating a pain-free, highly functional foot. In children with clubfoot associated with arthrogryposis, the Ponseti method is successful in creating a braceable foot that can delay the need for invasive surgical intervention. LEVEL OF EVIDENCE: Level III, Therapeutic Studies-Investigating the Results of Treatment.

Hip Surveillance for Children With Cerebral Palsy: A Survey of the POSNA Membership.

BACKGROUND: Currently, hip surveillance programs for children with cerebral palsy exist in Europe, Australasia, and parts of Canada, but a neuromuscular hip surveillance program has yet to be adopted in the United States. The purpose of this study was to report the current orthopaedic practice of hip surveillance in children with cerebral palsy, identify areas of practice variation, and suggest steps moving forward to generate guidelines for national neuromuscular hip surveillance. METHODS: The entire membership of the Pediatric Orthopaedic Society of North America (POSNA) was surveyed in 2016 for information regarding their practice for hip surveillance in children with cerebral palsy. Detailed information regarding timing, frequency, and practice of hip surveillance was obtained in answers to 26 different questions. RESULTS: A survey response rate of 27% was obtained (350/1300 members) during the study period. The majority of respondents treated pediatric patients exclusively (97%), worked in an academic practice (70%), and was affiliated with a university (76%). In total, 18% (69/350) of respondents followed a regular cerebral palsy hip surveillance program, about half of whom (44%, 30/69) had adopted the Australian guidelines. Respondents agreed that a dislocated hip in a child with cerebral palsy was painful (90% agreement) and should be prevented by hip surveillance (93% agreement). Furthermore, 93% of respondents indicated they would follow a national surveillance program if one was in place. Age (79%), Gross Motor Function Classification System (81%), and migration percentage (MP) (78%) were all identified as critical elements to a hip surveillance program. The majority of respondents felt that a hip "at risk" for hip displacement had a MP between 20% and 30% (57% of respondents), whereas surgery should be utilized once the MP exceeded 40% (50% of respondents). CONCLUSIONS: Results from this survey demonstrate 90% of respondents agree that a dislocated hip could be painful and 93% would follow a national surveillance program if available. At a societal level, we have the ability to standardize cerebral palsy hip surveillance, thereby decreasing practice variation and improving quality of care delivery. LEVELS OF EVIDENCE: Level V.

Full-thickness burn formation after the use of electrical stimulation for rehabilitation of unicompartmental knee arthroplasty.

Electrical stimulation and interferential current are commonly used modalities in the physical rehabilitation of patients who have undergone joint arthroplasty surgery. Sparse data are available in the literature regarding potential complications from using these modalities. We report on a patient who underwent a unicompartmental knee arthroplasty with a subsequent full-thickness skin burn over the metal implant after electrical stimulation and interferential current modalities in physical therapy.