Efficacy and late complications of percutaneous epiphysiodesis with transphyseal screws

Abstract

Percutaneous epiphysiodesis using transphyseal screws (PETS) has been developed for the treatment of lower limb discrepancies with the aim of replacing traditional open procedures. The goal of this study was to evaluate its efficacy and safety at skeletal maturity. A total of 45 consecutive patients with a mean skeletal age of 12.7 years (8.5 to 15) were included and followed until maturity. The mean efficacy of the femoral epiphysiodesis was 35% (14% to 87%) at six months and 66% (21% to 100%) at maturity. The mean efficacy of the tibial epiphysiodesis was 46% (18% to 73%) at six months and 66% (25% to 100%) at maturity. In both groups of patients the under-correction was significantly reduced between six months post-operatively and skeletal maturity. The overall rate of revision was 18% (eight patients), and seven of these revisions (87.5%) involved the tibia. This series showed that use of the PETS technique in the femur was safe, but that its use in the tibia was associated with a significant rate of complications, including a valgus deformity in nine patients (20%), leading us to abandon it in the tibia. The arrest of growth was delayed and the final loss of growth at maturity was only 66% of that predicted pre-operatively. This should be taken into account in the pre-operative planning.

Endoscopic-assisted epiphysiodesis

“…Given the improved cosmesis, decreased operative time, and reduced recovery time, percutaneous fluoroscopic-assisted epiphysiodesis has become the recommended method for treating moderate LLD [2,5,7,[10][11][12][13][14]. Multiple studies have demonstrated the efficacy and safety of percutaneous epiphysiodesis since its introduction in the 1980s [5,7,[10][11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Rates of incomplete physeal ablation have been shown to be similar (15%) for both open and percutaneous techniques for epiphysiodesis [23].…”

“…Although multiple studies have demonstrated that percutaneous epiphysiodesis offers decreased complications compared with the traditional open Phemister technique, a revision rate of nearly 20% has been reported [15]. Percutaneous epiphysiodesis using transphyseal screws (PETS) has also been described; this is accomplished without curettage of the physis.…”

“…Percutaneous epiphysiodesis using transphyseal screws (PETS) has also been described; this is accomplished without curettage of the physis. Ilharreborde et al [15] published a retrospective review of 45 patients who had undergone the PETS technique for epiphysiodesis. The authors reported a 66% efficacy rate at skeletal maturity.…”

“…The authors reported a 66% efficacy rate at skeletal maturity. However, with percutaneous transphyseal screws, nearly 30% of the revisions were related to painful hardware and 60% of the patients required a return to the operating room for hardware removal [15]. Ilharreborde and colleagues reported an 11% rate of screw breakage during removal.…”

Сучасний Погляд На Проблему Різниці Довжини Нижніх Кінцівок У Дітей Та Лікування Із Застосуванням Методів Керованого Росту (Літературний Огляд)

“…Автор описував цю техніку як малотравматичну, що має низький відсоток ускладнень. Ефективність використання гвинтів була продемонстрована рядом авторів, які отримали пози-тивні результати при корекції помірної РДНК [30,36,50,61].…”