Background

Surgical procedures such as femoral derotation osteotomies (FDO) and medial hamstrings lengthening (MHL) are crucial in the treatment of ambulatory children with CP. They can improve the children’s walking ability and function. However, there is a great variation in factors that influence the decision to perform these surgeries. This leads to both under- as well as overuse of these procedures in these children.

Both surgical procedures are commonly part of single-event multilevel surgeries (SEMLS) where multiple surgical procedures are included in one surgery to avoid repeat episodes of anaesthesia, hospitalisation, and rehabilitation. Unfortunately, the combination of procedures in SEMLS makes the evaluation of surgical indications and outcomes very challenging, especially in this heterogeneous population of children with CP.