Current Variation in the Postoperative Management of Patients With Cerebral Palsy Undergoing Lower Extremity Surgery: A Survey of Surgeon Practices.

Background: Children with cerebral palsy (CP) often develop lower limb deformities requiring surgical management. However, optimal postoperative management strategies-including weight-bearing progression, immobilization, and rehabilitation protocols-remain unclear. The purpose of this study was to evaluate current postoperative practices following lower extremity surgery in youth with CP. Methods: A 42-question electronic survey was sent to 114 practicing orthopaedic surgeons in the American Academy for Cerebral Palsy and Developmental Medicine. Six questions regarding seven surgical procedures (pelvic osteotomy, proximal femoral osteotomy, tibial osteotomy, isolated soft-tissue procedures, foot osteotomies, and foot fusions) were presented. Surgeons were asked about weight bearing, immobilization, initiation of physical therapy, standardized protocols, evaluation for inpatient rehabilitation, and educational sessions. Consensus was defined as >75% agreement for a given response (based on Delphi methodology). Results: Sixty-five surgeons from North America responded (57% response rate), with predominantly neuromuscular practices. Consensus was reached on only four of 42 questions (9.5%). Regarding weight bearing, 87.7% of surgeons allowed immediate weight bearing after isolated soft-tissue procedures. For immobilization, cast use reached consensus only for distal lower extremity surgeries including tibial osteotomy (95%), foot osteotomy (98%), and foot fusion (100%). Concerning rehabilitation and planning, no consensus was reached for any item. Conclusions: There was substantial heterogeneity in postoperative practices for children with CP undergoing lower extremity surgery. Other than immediate weight bearing after soft-tissue procedures and casting after distal bony procedures, no clear consensus emerged for weight-bearing progression, immobilization method, or rehabilitation planning. This variability may influence functional outcomes and patient satisfaction. Future studies regarding postoperative practices are warranted. Key Concepts: (1)Postoperative management varies widely for cerebral palsy (CP) patients after lower extremity surgery.(2)Weight-bearing protocols vary: some allow early weight bearing, while others restrict for 8 weeks.(3)No standardized guidelines exist for rehab after lower extremity surgery in CP. Level of Evidence: IV.