Osteotomy for deformities in blount disease: A systematic review

Phedy, Phedy; Siregar, Paruhum Ulitua

doi:10.1016/j.jor.2015.03.003

Cited by 11 publications

(7 citation statements)

References 23 publications

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“…There is really no consensus on the best osteotomy option; each method shows its own advantages and disadvantages [13,8] especially in severe forms in children over 4 years of age.…”

Section: Overall Resultsmentioning

confidence: 99%

“…Because of the relative rarity of Blount's disease and the length of the follow-up required for the validity of the results of its treatment by osteotomy, the publications relating to this subject are limited to date mainly to clinical cases, short series and retrospective studies for the most part [8] . Thus, this work suffers not only from its retrospective nature but also from local constraints characterized by the weakness of the technical platform.…”

Section: Discussionmentioning

confidence: 99%

“…Several therapeutic options can be used. Among them, the raising of the medial tibial plateau accompanied by associated gestures necessary according to the case [7,8,9] . The literature proposes a single-time operative strategy to solve all the problems [7] .…”

Section: Introductionmentioning

confidence: 99%

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Medial tibial plateau elevation by double osteotomy in severe Blount’s disease in low-income country: Short-term outcomes

Kanfitine,

TH,

et al. 2023

Int. J. Orthop. Sci.

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Introduction: Blount disease is a growth affection characterized by disordered endochondral ossification of the medial part of the proximal tibial physis resulting in multiplanar deformities of the lower limb. Their management is complex and must consider the deformations associated in all the plans. Several therapeutic options can be used. We report a series of 31 patients treated by osteotomy in single step operative procedure. Patients and Methods: It was a retrospective study relating a series continues prospective of 39 knees (31 patients) treated in three different centers in the same period between January 2012 and September 2020. All the patients had an advanced genu varum in the setting of Blount's disease. All the patients had a preoperative pangonometry. The procedure began with a closing-wedge distal femoral osteotomy fixed by plate, when the femoral valgus was associated. The operative procedure comprised four stages. a fibular osteotomy, double tibial osteotomy, osteotomy of the medial tibial plateau and hemiepiphysiodesis of the lateral proximal tibial epiphysis. All the patients were followed clinically and by radiographs in 45 th , 60 th and 180 th day. The clinical assessment and functional calculus were based on the criteria of Schoenecker. Results: At the last 7.4 months follow-up (3 -13), no complications were observed. Bone consolidation was acquired in 100% of cases. The Schoenecker score was considered good in 10/23 patients (43.47%) and average in 12/23 patients (52.21%). In three (3) patients, the results were considered poor. Two (2) of them were repeated for better restoration of the joint space and the last one was lost to follow-up Conclusion: Blount disease is rare but can be severe. Double ostetomy of medial tibial plateau remains a therapeutic option in the context of developing countries.

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“…There is really no consensus on the best osteotomy option; each method shows its own advantages and disadvantages [13,8] especially in severe forms in children over 4 years of age.…”

Section: Overall Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Medial tibial plateau elevation by double osteotomy in severe Blount’s disease in low-income country: Short-term outcomes

Kanfitine,

TH,

et al. 2023

Int. J. Orthop. Sci.

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“…Several systematic reviews have been conducted on Blount's disease. However, this study represents the most comprehensive systematic review, comparing the results of all reported surgical treatments for Blount's disease in children, largely encompassing previous systematic reviews on the same topic, which each investigated between 4 and 32 studies [1,[78][79][80][81][82][83]. This study is the first systematic review that compared the results of all surgical methods applied in the treatment of Blount's disease.…”

Section: Discussionmentioning

confidence: 99%

Recurrence and Complication Rates of Surgical Treatment for Blount’s Disease in Children: A Systematic Review and Meta-Analysis

Ramella,

Depaoli,

Menozzi

et al. 2023

JCM

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Background: Blount’s disease is a growth disorder of the proximal tibia that causes progressive genu varum in children. Surgical treatment is recommended if the deformity worsens, but which intervention is best remains controversial. This study aims to identify factors influencing outcomes and determine the most effective surgical approach. Methods: A systematic review was conducted of studies published before January 2022. Results: In total, 63 retrospective studies with CEBM IIIb/IV levels were included (1672 knees in 1234 patients). The most commonly reported treatment was acute correction via osteotomy (47%), followed by hemiepiphysiodesis (22%) and gradual correction (18%). Combined procedures were reported in 13% of cases. The overall recurrence rate was 18%, with a significant difference when comparing the recurrence rates after gradual correction with those after hemiepiphysiodesis (7% and 29%, respectively). Major complications beyond recurrence were observed in 5% of cases. A meta-analysis of the available raw data showed a significantly increased recurrence rate (39%) among treated children who were between 4.5 and 11.25 years of age and were followed for a minimum follow-up of 2.5 years. Conclusions: Overall, poor evidence with which to establish an optimal treatment for Blount’s disease was found. This study remarked on the need for early diagnosis, classification, and treatment of infantile tibia vara, since a significant rate of recurrence was found in neglected cases.

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“…Early tibial valgus osteotomy has been shown to reduce the risk of recurrence [4][5][6][7] by presumably relieving the compressive forces on the physis and allowing recovery. Despite early osteotomy, the recurrence rate is as high as 94% 8 and increases with the duration of follow-up. 9 Some authors have recommended hemiepiphyseodesis at the same time as osteotomy, in children between 5 and 8 years of age, to minimize this recurrence.…”

mentioning

confidence: 99%

Guided Growth for Varus Deformity Following Early Tibial Osteotomy in Infantile Tibia Vara—A Multi-Center Study

Walker

Scott²,

Stephenson³

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Despite early osteotomy, many patients with infantile tibia vara (ITV) have persistent or recurrent varus deformity and disordered growth at the medial proximal tibial physis. Our hypothesis was that lateral tibial tension band plating (LTTBP) could guide correction. Methods: A retrospective review at 6 centers of 15 patients (16 extremities) was performed of LTTBP for varus deformity following early osteotomy in ITV, diagnosed≤4years of age. Correction of deformity parameters on digital standing anteroposterior lower extremity radiographs determined outcome. Results: Twenty-two LTTBP procedures were performed at mean age of 7.5 years, including 4 revisions for implant failure and 2 reimplantations for recurrence. Single event LLTBP, improved the medial proximal tibial angle with a mean change of 13.4 degrees (0.39 degrees/month). Eleven limbs had preoperative mechanical lateral distal femoral angle (mLDFA)>90 degrees. While n degree femoral procedures were performed, at study end, 11 femurs had mechanical lateral distal femoral angle≤90°. Pretreatment, 13 extremities had mechanical axis zone (MAZone) III varus (81%) and 3 had MAZone II varus (19%). LTTBP’s were able to initially correct 13 limbs to MAZone I or valgus but 4 limbs rebounded to MAZone II varus after implant removal. Final limb alignment, after all surgeries and rebound, included 9 in MAZone I, 5 in MAZone II varus and 2 in MAZone III varus. Average follow-up was 3.0 years at mean 10.7 years of age. Fifteen procedures resulted in improvement in MAZone and 7 had no change. On average, those that improved were younger (7.3 vs. 8.0 y), weighed less (45.5 kg with body mass index 26.5 kg/m2 vs. 67.8 kg and body mass index 35.7 kg/m2), had lower mechanical axis deviation (37.1 mm vs. 43.9 mm), lower medial physeal slope (61.7 vs. 68.7 degrees) and had a higher percentage of open triradiate phases (87 vs. 57%). Conclusions: LTTBP for residual varus, after initial osteotomy in ITV, resulted in 81% of limbs initially achieving MAZone I or valgus with implant failure revisions and femoral remodeling. Rebound after implant removal reduced the corrected rate to 56%. Ninety-four percent avoided osteotomy during the study period. Level of Evidence: IV

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Osteotomy for deformities in blount disease: A systematic review

Cited by 11 publications

References 23 publications

Medial tibial plateau elevation by double osteotomy in severe Blount’s disease in low-income country: Short-term outcomes

Medial tibial plateau elevation by double osteotomy in severe Blount’s disease in low-income country: Short-term outcomes

Recurrence and Complication Rates of Surgical Treatment for Blount’s Disease in Children: A Systematic Review and Meta-Analysis

Guided Growth for Varus Deformity Following Early Tibial Osteotomy in Infantile Tibia Vara—A Multi-Center Study

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