Temporary hemiepiphysiodesis for correcting idiopathic and pathologic deformities of the knee: A retrospective analysis of 355 cases

Radtke, Kerstin; Goede, Fabian; Schweidtmann, Katharina; Schwamberger, Tanja; Calließ, Tilman; Fregien, Bastian; Stukenborg-Colsman, Christina; Ettinger, Max

doi:10.1016/j.knee.2020.04.024

Cited by 6 publications

(32 citation statements)

References 21 publications

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“…The results of this study refer to children aged 10 years and older, in whom the spontaneous correction potential is already reduced. Radtke et al [8] indicate a THE of the knee at a MAD of > 10 mm, regardless of whether the deviation is medial or lateral. They were not using the MFA for indication.…”

Section: Discussionmentioning

confidence: 99%

“…For children and adolescents, there is a wide range of normal values concerning axis deviation of the lower limb, which need to be differentiated from pathological and pre-arthritic deformities prior to surgical intervention [7]. As a surgical treatment, temporary hemiepiphysiodesis (THE) of the distal femur or proximal tibia using tension band plates, depending on the location of the pathologic joint surface angles, has become established for axis correction of children and adolescents [8,9]. However, the exact patient age for the best possible correction and the lowest probability of rebound remains unclear.…”

Section: Introductionmentioning

confidence: 99%

“…Malalignment of the lower extremity is one of the most common reasons for an orthopedic consultation. An accurate and reliable radiological assessment of lower limb alignment is essential for clinical decision-making on treatment of limb deformities and for regular control after a surgical intervention [8,12]. The full-length standing anteroposterior radiograph of both legs is the gold standard for assessment of lower limb alignment in frontal plane [13].…”

Section: Introductionmentioning

confidence: 99%

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Intra- and interobserver reliability analysis of pediatric lower limb parameters on digital long leg radiographs

et al. 2023

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Background Malalignments of the lower extremity are common reasons for orthopedic consultation because it may lead to osteoarthritis in adulthood. An accurate and reliable radiological assessment of lower limb alignment in children and adolescents is essential for clinical decision-making on treatment of limb deformities and for regular control after a surgical intervention. Objective First, does the analysis of full-length standing anteroposterior radiographs show a good intra- and interobserver reliability? Second, which parameter is most susceptible to observer-dependent errors? Third, what is the Standard Error of Measurement (SEM95%) of the absolute femoral and tibial length? Methods Two observers evaluated digital radiographs of 144 legs from 36 children and adolescents with pathological valgus alignment before a temporary hemiepiphysiodesis and before implant removal. Parameters included Mechanical Femorotibial Angle (MFA), Mechanical Axis Deviation (MAD), mechanical Lateral Distal Femoral Angle (mLDFA), mechanical Medial Proximal Tibial Angle (mMPTA), mechanical Lateral Proximal Femoral Angle (mLPFA), mechanical Lateral Distal Tibial Angle (mLDTA), Joint Line Convergence Angle (JLCA), femur length, tibial length. Intra- and interobserver reliability (ICC2,1), SEM95% and proportional errors were calculated. Results The intra- and interobserver reliability for almost all measurements was found to be good to excellent (Intra-ICC2,1: 0.849–0.999; Inter-ICC2,1: 0.864–0.996). The SEM95% of both observers was found to be ± 1.39° (MFA), ± 3.31 mm (MAD), ± 1.06° (mLDFA) and ± 1.29° (mMPTA). The proportional error of MAD and MFA is comparable (47.29% vs. 46.33%). The relevant knee joint surface angles show a lower proportional error for mLDFA (42.40%) than for mMPTA (51.60%). JLCA has a proportional error of 138%. Furthermore, the SEM95% for the absolute values of the femoral and tibial length was 4.53 mm for the femur and 3.12 mm for the tibia. Conclusions In conclusion, a precise malalignment measurement and the knowledge about SEM95% of the respective parameters are crucial for correct surgical or nonsurgical treatment. The susceptibility to error must be considered when interpreting malalignment analysis and must be considered when planning a surgical intervention. The results of the present study elucidate that MAD and MFA are equally susceptible to observer-dependent errors. This study shows good to excellent intra- and interobserver ICCs for all leg alignment parameters and joint surface angles, except for JLCA. Trial registration: This study was registered with DRKS (German Clinical Trials Register) under the number DRKS00015053. Level of evidence I, Diagnostic Study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intra- and interobserver reliability analysis of pediatric lower limb parameters on digital long leg radiographs

et al. 2023

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“…The current literature on hemiepiphysiodesis plating focuses on clinical outcomes, particularly its effectiveness as a guided growth system for correcting deformities, the speed of correction, and the incidence of rebound compared with other procedures [ 3 , 10 , 11 ]. However, Gregoire et al [ 8 ] showed that 38% of patients still needed to take pain medication four weeks after temporary hemiepiphysiodesis and 65% did not return to previous activities during that time.…”

Section: Introductionmentioning

confidence: 99%

Factors for Prolonged Pain and Restriction of Movement Following Hemiepiphysiodesis Plating for the Correction of Lower Limb Malalignment in the Frontal Plane: An Explorative Analysis

et al. 2023

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The correction of valgus leg malalignment in children using implant-mediated growth guidance is widely used and effective. Despite the minimal invasive character of the procedure, a relevant number of patients sustain prolonged pain and limited mobility after temporary hemiepiphysiodesis. Our aim was to investigate implant-associated risk factors (such as implant position and screw angulation), surgical- or anesthesia-related risk factors (such as type of anesthesia, use, and duration), and pressure of tourniquet or duration of surgery for these complications. Thirty-four skeletally immature patients with idiopathic valgus deformities undergoing hemiepiphysiodesis plating from October 2018–July 2022 were enrolled in this retrospective study. Participants were divided into groups with and without prolonged complications (persistent pain, limited mobility of the operated knee between five weeks and six months) after surgery. Twenty-two patients (65%) had no notable complications, while twelve patients (35%) had prolonged complications. Both groups differed significantly in plate position relative to physis (p = 0.049). In addition, both groups showed significant differences in the distribution of implant location (p = 0.016). Group 1 had a shorter duration of surgery than group 2 (32 min vs. 38 min, p = 0.032) and a lower tourniquet pressure (250 mmHg vs. 270 mmHg, p = 0.019). In conclusion, simultaneous plate implantation at the femur and tibia and metaphyseal plate positioning resulted in prolonged pain and a delay of function. In addition, the amplitude of tourniquet pressure or duration of surgery could play a factor.

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“…9 Stevens' technique has been widely applied to successfully treat lower extremity deformities in skeletally immature patients with reported complications of screw backout, screw breakage, and overcorrection if lost to follow-up. [10][11][12] Guided growth for distal tibia valgus with both a distal tibia medial malleolar screw and a figureof-eight plate has been reported. [13][14][15] Lower extremity deformity correction by guided growth has also been reported in metabolic bone conditions such as renal osteodystrophy, nutritional rickets, and Morquio-Brailsford syndrome.…”

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confidence: 99%

Multicenter Series of Deformity Correction Using Guided Growth in the Setting of Osteogenesis Imperfecta

Franzone

Wallace

Rogers

et al. 2022

Journal of Pediatric Orthopaedics

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Background: The mainstay of deformity correction and fracture prevention for patients with osteogenesis imperfecta (OI) includes osteotomies and intramedullary rodding. Guided growth, described in the setting of skeletal dysplasias, offers a less invasive means of deformity correction. We report a multicenter case series of guided growth procedures in the setting of OI. Methods: We retrospectively reviewed patients with OI at three institutions from April 2012 to April 2019: 18 patients underwent guided growth for angular deformity correction with minimum 1-year follow-up or full deformity correction and removal of guided growth hardware. Clinical characteristics, deformity measurements, and complications were collected. Distal femoral and proximal tibial hemiepiphysiodesis was performed using figure-of-eight plates and screws, and distal tibial medial hemiepiphysiodesis with cannulated screws. Preoperative and postoperative lateral distal femoral angle, medial proximal tibial angle, and lateral distal tibial angle were measured. Frequency and descriptive statistics were completed. Results: Eighteen patients with OI (five-I, four-III, six-IV, three-V) underwent 33 guided growth procedures with mean follow-up of 3.09 years; all received routine bisphosphonate treatment. Preoperative and postoperative mean joint angles were measured. The location for hemiepiphysiodesis included 8 distal femoral medial, 2 distal femoral lateral, 8 proximal tibial medial, 3 proximal tibial lateral, and 12 distal tibial medial. Twelve of the 33 procedures were in patients who had an intramedullary rod; 1 demonstrated backout of the epiphyseal and metaphyseal screws of a distal femoral medial figure-of-eight plate. It was revised to a larger plate with longer screws and removed upon completion of deformity correction. Conclusion: Guided growth may be used as an effective means of angular deformity correction with dysplastic OI bone. Having an intramedullary rod did not preclude the use of a guided growth technique. One procedure demonstrated screw backout. Given the short stature associated with OI, performing a guided growth procedure at an early enough age to allow time for correction should be considered. Level of Evidence: Level IV-case series.

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Temporary hemiepiphysiodesis for correcting idiopathic and pathologic deformities of the knee: A retrospective analysis of 355 cases

Cited by 6 publications

References 21 publications

Intra- and interobserver reliability analysis of pediatric lower limb parameters on digital long leg radiographs

Intra- and interobserver reliability analysis of pediatric lower limb parameters on digital long leg radiographs

Factors for Prolonged Pain and Restriction of Movement Following Hemiepiphysiodesis Plating for the Correction of Lower Limb Malalignment in the Frontal Plane: An Explorative Analysis

Multicenter Series of Deformity Correction Using Guided Growth in the Setting of Osteogenesis Imperfecta

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