Clin Orthop Surg.  2016 Mar;8(1):92-98. 10.4055/cios.2016.8.1.92.

The Efficacy of Percutaneous Lateral Hemiepiphysiodesis on Angular Correction in Idiopathic Adolescent Genu Varum

• Woo K
• Lee YS
• Lee WY
• Shim JS

• KMID: 2363951
• DOI: http://doi.org/10.4055/cios.2016.8.1.92

Abstract

BACKGROUND
Percutaneous lateral hemiepiphysiodesis of the lower extremity is a simple and excellent method to correct the angular and length problems cosmetically. However, the efficacy of percutaneous lateral hemiepiphysiodesis is not well established in the literature. The purpose of this study was to evaluate the efficacy of percutaneous lateral hemiepiphysiodesis for angular corrections in adolescent idiopathic genu varum patients with proximal tibia vara and identify the factors affecting the amount of deformity correction of the lower limb in the coronal plane.
METHODS
We retrospectively reviewed 20 patients (40 lower limbs) who had percutaneous lateral hemiepiphysiodesis on the proximal lateral tibia between 1997 and 2010. Radiographic evaluations were made using (1) the hip-knee-ankle angle and (2) the length of the tibia. Furthermore, the intercondylar distance was evaluated at the level of the knee joint. Preoperative factors (gender, age, body mass index, intercondylar distance, preoperative hip-knee-ankle angle, remaining growth of tibia, and calculated correctable angle) were analyzed, as well as their correlation with the degree of the actual correction angle.
RESULTS
The amount of coronal deformity of the lower limb was improved from its preoperative state. The median average of hip-knee-ankle angle improved from 8.0degrees (interquartile range [IQR], 7.0degrees to 10.0degrees) preoperatively to 3.0degrees (IQR, 2.5degrees to 4.0degrees) at the final follow-up (p < 0.001). The median percent ratio of the angular correction was 60% (IQR, 50% to 71.3%). The correlation coefficients were -0.537, 0.832, 0.791, and 0.685 for the bone age, preoperative hip-knee-ankle angle, the remaining growth of tibia, and calculated correctable angle, respectively.
CONCLUSIONS
Despite the excellent cosmetic outcome of percutaneous lateral hemiepiphysiodesis on the proximal lateral tibia in adolescent idiopathic genu varum, the effect was limited in most cases. For optimum results, surgery a few months earlier is recommended, rather than at the calculated operation time.

Keyword

Idiopathic adolescent genu varum; Percutaneous permanent hemiepiphysiodesis; Proximal tibia

MeSH Terms

Adolescent
Child
Female
Genu Varum/diagnostic imaging/pathology/*surgery
Humans
Leg Bones/diagnostic imaging/pathology/surgery
Male
Orthopedic Procedures/*methods
Retrospective Studies
Tibia/diagnostic imaging/pathology/*surgery
Treatment Outcome

Figure

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  Fig. 1 Schematic presentation for the correctable angle by asymmetrical lateral proximal tibia epiphysiodesis.

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  Fig. 2 Comparison of the correction angle between the calculated expectation values and actual values. CCA: calculated correctable angle, ACA: actual correction angle at final follow-up.

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  Fig. 3 Case number 3. A 10.3-year-old girl (bone age). (A) Preoperative radiograph. (B) Perfect alignment was achieved 2 years postoperatively when skeletal maturity was reached. *Hip-knee-ankle angle.

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  Fig. 4 Case number 11. A 12.3-year-old girl (bone age). (A) Preoperative radiograph. (B) There was no improvement of angular deformity at final follow-up. *Hip-knee-ankle angle.

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