Osteotomy treatments and post-operative fixations for Blount disease: A systematic review

Sananta, Panji; Santoso, Joko; Sugiarto, Muhammad Alwy

doi:10.1016/j.amsu.2022.103784

Cited by 3 publications

(5 citation statements)

References 17 publications

(122 reference statements)

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“…Sananta et al, by reviewing 15 studies and only focusing on osteotomies, concluded that, despite the unpredictable results, most authors recommended corrective osteotomy, preferably before age 4, in line with our findings [83]. Moreover, they suggested applying other techniques according to deformity severity, but found no significant benefit in combined techniques [83]. Burghardt et al conducted a narrative review of twelve studies about hemiepiphysiodesis for the treatment of Blount's disease, concluding that the isolated use of this procedure may lead to poorly predictable results and frequent under-correction [80].…”

Section: Discussionsupporting

confidence: 86%

“…Phedy and Siregar compared various osteotomy techniques and fixation methods among four studies, and did not report any conclusion based on their statistical analysis of the data, but recommended surgery tailored according to the patient's age and the surgeon's skills [79]. Sananta et al, by reviewing 15 studies and only focusing on osteotomies, concluded that, despite the unpredictable results, most authors recommended corrective osteotomy, preferably before age 4, in line with our findings [83]. Moreover, they suggested applying other techniques according to deformity severity, but found no significant benefit in combined techniques [83].…”

Section: Discussionsupporting

confidence: 50%

“…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%

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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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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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“…This could be due to many factors: (1) the specific features of the disease, (2) age, (3) inappropriate osteotomy type and (4) insufficient correction and/or lack of overcorrection. As observed in the treatment of ITV, there is a very high incidence of recurrence of varus deformity in children, and most authors recommend the correction to be made before age 4 [39]. Moreover, previous studies in ITV recommended an average overcorrection of 15 • for preventing a relapse [40].…”

Section: Discussionmentioning

confidence: 99%

Virtual Surgical Planning, 3D-Printing and Customized Bone Allograft for Acute Correction of Severe Genu Varum in Children

Alessandri

Frizziero

Santi

et al. 2022

JPM

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Complex deformities of lower limbs are frequent in children with genetic or metabolic skeletal disorders. Early correction is frequently required, but it is technically difficult and burdened by complications and recurrence. Herein, we described the case of a 7-year-old girl affected by severe bilateral genu varum due to spondyloepiphyseal dysplasia. The patient was treated by patient-specific osteotomies and customized structural wedge allograft using Virtual Surgical Planning (VSP) and 3D-printed patient-specific instrumentation (PSI). The entire process was performed through an in-hospital 3D-printing Point-of-Care (POC). VSP and 3D-printing applied to pediatric orthopedic surgery may allow personalization of corrective osteotomies and customization of structural allografts by using low-cost in-hospital POC. However, optimal and definitive alignment is rarely achieved in such severe deformities in growing skeleton through a single operation.

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“…All Blount disease patients who met the indications, including the age older than 3 years, Langenskiöld stage 3, and failure of conservative treatment 15,16 were scheduled for surgery. We performed a proximal tibial valgus osteotomy below the tibial tubercle using a dome or closewedged osteotomy.…”

Section: Surgical Techniquementioning

confidence: 99%

A Predictive Score for Infantile Blount Disease Recurrence After Tibial Osteotomy

Adulkasem

Wongcharoenwatana

Ariyawatkul

et al. 2023

Journal of Pediatric Orthopaedics

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Introduction and Objective: Several predictive factors for infantile Blount disease recurrence after tibial osteotomy were discovered. This study aimed to examine and utilize various predictors to develop a prediction score for infantile Blount disease recurrence after tibial osteotomy. Methods: We conducted a retrospective cohort study of infantile Blount disease patients who underwent tibial osteotomy between January 1998 and December 2020. Potential predictors, including clinical and radiographic parameters, were examined for their association with the disease recurrence after receiving tibial osteotomy. A predictive score was subsequently developed based on those potential predictors through multivariable logistic regression modeling. Results: A total of 101 extremities diagnosed with infantile Blount disease from 58 patients who underwent tibial osteotomy were included. Of those, 15 extremities (14.9%) recurred. Univariable logistic regression analysis identified age older than 42 months [odds ratio (OR)=4.28; P=0.026], Langenskiöld classification stage III (OR=9.70; P <0.001), LaMont classification type C (OR=15.44; P <0.001), preoperative femorotibial angle <−14 degrees (OR=4.21, P=0.021), preoperative metaphyseal-diaphyseal angle >16 degrees (OR=8.61, P=0.006), preoperative medial metaphyseal slope angle >70 degrees (OR=7.56, P=0.001), and preoperative medial metaphyseal beak angle >128.5 degrees (OR=13.46, P=0.001) as potential predictors of infantile Blount disease recurrence after tibial osteotomy. A predictive score comprised of age younger than 42 months, LaMont classification type C, and medial metaphyseal beak angle >128 degrees demonstrated an excellent predictive performance (area under the receiver operating characteristic curve =0.87), good calibration, and high internal validity. Conclusions: Our developed predictive score accurately predicted infantile Blount disease recurrence after tibial osteotomy. The results from our developed prediction tool allow physicians to inform prognosis, increase awareness during the follow-up period, and consider additional interventions to prevent disease recurrence. Level of Evidence: Level II

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Osteotomy treatments and post-operative fixations for Blount disease: A systematic review

Cited by 3 publications

References 17 publications

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

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

Virtual Surgical Planning, 3D-Printing and Customized Bone Allograft for Acute Correction of Severe Genu Varum in Children

A Predictive Score for Infantile Blount Disease Recurrence After Tibial Osteotomy

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