Abstract
BACKGROUND: Bladder exstrophy (BE) is a rare congenital anomaly associated with complex urogenital malformations and musculoskeletal sequelae. Despite surgical advances, the long-term biomechanical implications of reconstructive procedures, particularly on gait and pelvic kinematics, remain underexplored. Previous studies have reported inconsistent findings regarding hip motion, pelvic tilt, and gait symmetry, and the influence of osteotomy on locomotor function is not well defined. This study aimed to investigate long-term gait and pelvic biomechanics in patients with BE following childhood surgical repair, to evaluate the effects of pelvic osteotomy, and to determine correlations between radiographic pubic diastasis and quantitative gait parameters. METHODS: This retrospective cross-sectional study included 27 patients (20 males, 7 females; age 12-33 years) treated for BE at a tertiary pediatric surgery center. All participants underwent comprehensive evaluation including clinical history, physical examination, radiological assessment, and three-dimensional gait analysis using a motion capture system with reflective markers. Parameters assessed included trunk and pelvic rotation, pelvic obliquity, hip abduction, and electromyographic muscle activation. Subgroup analyses compared patients with and without osteotomy, and correlations between gait parameters and radiographic pubic diastasis were examined. Data were analyzed using Student's t-test, Mann-Whitney U test, Chi-square/Fisher's exact test, and Spearman correlation, with p < 0.05 considered significant. RESULTS: Quantitative gait analysis demonstrated significant deviations compared with normative values, including a 5° increase in trunk obliquity at initial contact, a 3° decrease during pre-swing, and a 10° increase in bilateral hip abduction during the swing phase. Patients with a history of osteotomy exhibited greater posterior pelvic tilt and increased pelvic obliquity during swing (p < 0.01). Pubic diastasis correlated with trunk and pelvic rotation parameters (rho values ranging from - 0.585 to 0.552, p < 0.05). Despite these measurable deviations, none of the participants reported difficulties in daily activities, school attendance, or recreational physical activity, indicating effective neuromuscular compensation. CONCLUSIONS: Bladder exstrophy patients demonstrate persistent alterations in pelvic biomechanics and gait kinematics in long-term follow-up, particularly after pelvic osteotomy. However, these changes did not translate into clinically limiting impairments, highlighting the adaptive capacity of the neuromuscular system. Quantitative gait analysis provides objective insights into musculoskeletal sequelae and underscores the importance of tailored long-term surveillance strategies.