Risk factors for failure of temporary hemiepiphysiodesis in Blount disease: a systematic review

Fan, Bensen; Zhao, Chen; Sabharwal, Sanjeev

doi:10.1097/bpb.0000000000000603

Cited by 17 publications

(32 citation statements)

References 29 publications

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“…Complete correction of the mTFA, MAD, and MAZone by GMS, was only successful in 40%, 47%, and 49% of limbs, respectively. The definition of success for hemiepiphyseodesis and GMS in LOTV has no clear consensus among investigators 6–10,15–17. Reported success rates of achieving normal adult limb parameters range from 33% to 67%, comparable to our study 7,10,15,16.…”

Section: Discussionsupporting

confidence: 74%

“…The reported success of hemiepiphyseodesis for the management of tibia vara through “growth modulation” has been disappointing when compared with other diagnoses 4–6. The literature cites age, severity of deformity, and body mass index (BMI) as predictors of poor results of hemiepiphyseodesis in LOTV 6–10. However, these conclusions are predicated on studies, which frequently have small sample sizes, heterogeneous groups of patients (early and late-onset) managed with varying techniques, or results from meta-analyses 6,9.…”

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confidence: 99%

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Predicting Deformity Correction of Growth Modulation in Late-onset Tibia Vara

Walker

Dueber

Powell

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Growth modulation in late-onset tibia vara (LOTV) has been reported to yield variable results. We hypothesized that parameters of deformity severity, skeletal maturity, and body weight could predict the odds of a successful outcome. Methods: A retrospective review of tension band growth modulation for LOTV (onset ≥8 y) was performed at 7 centers. Tibial/overall limb deformity and hip/knee physeal maturity were assessed on preoperative anteroposterior standing lower-extremity digital radiographs. Tibial deformity change with first-time lateral tibial tension band plating (first LTTBP) was assessed by medial proximal tibia angle (MPTA). Effects of a growth modulation series (GMS) on overall limb alignment were assessed by mechanical tibiofemoral angle (mTFA) and included changes from implant removal, revision, reimplantation, subsequent growth, and femoral procedures during the study period. The successful outcome was defined as radiographic resolution of varus deformity or valgus overcorrection. Patient demographics, characteristics, maturity, deformity, and implant selections were assessed as outcome predictors using multiple logistic regression. Results: Fifty-four patients (76 limbs) had 84 LTTBP procedures and 29 femoral tension band procedures. For each 1-degree decrease in preoperative MPTA or 1-degree increase in preoperative mTFA the odds of their successful correction decreased by 26% in the first LTTBP and 6% by GMS, respectively, controlling for maturity. The change in odds of success for GMS assessed by mTFA was similar when controlling for weight. Closure of a proximal femoral physis decreased the odds of success for postoperative-MPTA by 91% with first LTTBP and for final-mTFA by 90% with GMS, controlling for preoperative deformity. Preoperative weight ≥100 kg decreased the odds of success for final-mTFA with GMS by 82%, controlling for preoperative mTFA. Age, sex, race/ethnicity, type of implant, and knee center peak value adjusted age (a method for bone age) were not predictive of outcome. Conclusions: Resolution of varus alignment in LOTV using first LTTBP and GMS, as quantified by MPTA and mTFA, respectively, is negatively impacted by deformity magnitude, hip physeal closure, and/or body weight ≥100 kg. The presented table, utilizing these variables, is helpful in the prediction of the outcome of the first LTTBP and GMS. Even if complete correction is not predicted, growth modulation may still be appropriate to reduce deformity in high-risk patients. Level of Evidence: Level III.

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Section: Discussionsupporting

confidence: 74%

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confidence: 99%

Predicting Deformity Correction of Growth Modulation in Late-onset Tibia Vara

Walker

Dueber

Powell

et al. 2023

Journal of Pediatric Orthopaedics

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“…The explanation we could use is that children reach skeletal maturity before total correction. Recently a systematic review by Fan et al found no correlation between age at surgery or implant type and hemiphysiodesis failure, but their database was heterogeneous [16]. Another complication related to growth rebound with recurrence of the deformity suggests waiting for valgus hypercorrection before removing the material.…”

Section: Discussionmentioning

confidence: 99%

Guided Growth Vs. Tibial Osteotomy in Early Stage of Blount Disease

Assan¹,

Simon

Adjadohoun

et al. 2021

Preprint

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Background: There are no real comparative study between guided growth and tibial osteotomy in early stage of Blount disease. The aim of this work was to compare the results of patients treated by these two techniques. Method: We had performed a multicenter retrospective, descriptive and analytical study over a period of 05 years. All children admitted for Blount disease without medial proximal tibial epiphysiodesis and treated by one of these techniques were included. Age, sex, existence of tibial torsion, radiological stage based on Catonne's classification were studied. We also evaluated preoperatively, immediately postoperatively, and at latest follow-up tibiofemoral angle, mechanical medial proximal tibial angle, mechanical lateral distal femoral angle, and the tibial metaphyso-diaphyseal angle. Results: Seventeen (17) patients for 24 knees were included. The sex ratio was 0.54. All patients had tibial torsion. Fourteen knees (64%) were treated by guided growth at a mean age of 5.5±2.5 (range, 3-9 years). With a mean follow-up of 12 ± 3.5 months (range 6-15month); tibiofemoral, mechanical medial proximal tibial, and tibial metaphyso-diaphyseal angles were significantly corrected with normalization of the mechanical axis in 8 patients (60%). Ten patients (36%) were treated by revisited Rab osteotomy at a mean age of 7.7±4.9 years (range, 4-12 years). At a mean follow-up of 23±15 months (range, 10-48 months), only tibial metaphyso-diaphyseal angle was significantly corrected. The recurrence rate was 60%. Despite perfect correction of tibiofemoral, and mechanical medial proximal tibial angles in immediate postoperative follow-up, they gradually decrease in patients treated by Rab osteotomy, whereas they gradually increased in case of guided growth. Conclusion: Guided growth appears to be the best treatment for early stage of Blount disease. Trial registration: Retrospectively registered

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“…[24] Implant failure is more common in patients with obesity and the population under the age of 10 years, and it is recommended to use larger or more solid screws with stronger constructs. [28] Different sizes of K-wire and cerclage are used frequently in the clinical practice. We believe that a larger K-wire and cerclage can be used to increase the fixation strength.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two types of fixation for proximal tibial epiphysiodesis: An experimental study in a rabbit model

Bayrak

Duramaz

Kızılkaya³

et al. 2021

Jt Dis Relat Surg

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Objectives: In this study, we describe a novel hemiepiphysiodesis technique to prevent implant-related perichondrial ring injury in a rabbit model. Materials and methods: Proximal tibial epiphyseal plates of a total of 16 white New Zealand rabbits were used for this animal model. The subjects were divided into three equal groups as follows: Group 1 (Kirschner wire [K-wire]/cerclage), Group 2 (8-plate) right-hind legs, Group 3 (Control) left hind legs. Using anteroposterior radiography, the medial slope angle (MSA), articular line-diaphyseal angle (ALDA), and the angle between screws of 8-plate in lateral X-ray tibial slope angle (TSA) were measured. The radiographs were taken early postoperative (Day 1) and on sacrification day (Week 8). The histological evaluation of the perichondrial ring was made on a 7-mm axial section that stained with Safranin O/fast green at X10 magnification. Results: In both K-wire and 8-plate groups, the early postoperative ALDA and TSA were greater than the sacrification ALDA and TSA (p=0.028 and p<0.001, respectively). The early postoperative MSA was lower than the sacrification MSA in groups, (p<0.001). The MSA in the control group was lower than the K-wire and 8-plate groups (p<0.001 and p=0.009; respectively). The perichondrial ring thickness of the K-wire group was greater than the 8-plate group in histological evaluation (p<0.001). Conclusion: Both of the K-wire and 8-plate groups showed similar angulation effects in the proximal tibia, although histologically less damage to the perichondrial ring was observed in the K-wire group, compared to the 8-plate group.

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Risk factors for failure of temporary hemiepiphysiodesis in Blount disease: a systematic review

Cited by 17 publications

References 29 publications

Predicting Deformity Correction of Growth Modulation in Late-onset Tibia Vara

Predicting Deformity Correction of Growth Modulation in Late-onset Tibia Vara

Guided Growth Vs. Tibial Osteotomy in Early Stage of Blount Disease

Comparison of two types of fixation for proximal tibial epiphysiodesis: An experimental study in a rabbit model

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