TY - JOUR
T1 - Prediction of loss of correction after hemiepiphysiodesis for the alignment of lower limb angular deformities
AU - Schagemann, Jan
AU - Kudernatsch, Nils
AU - Russlies, Martin
AU - Mittelstädt, Hagen
AU - Götze, Melanie
AU - Horter, Melanie
AU - Paech, Andreas
AU - Behnke, Barbara
N1 - Publisher Copyright:
Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.
PY - 2022/1/21
Y1 - 2022/1/21
N2 - Guided growth by temporary hemiepiphysiodesis (HEPD) is established for the alignment of lower limb angular deformities. This retrospective cohort study was designed to assess the effect of HEPD in idiopathic coronal plane deformities around the knee and on the frontal knee joint line orientation, and to test the frontal knee joint line as predictive means for recurrence. Fourty-four patients (78 deformities: valgus n = 64, varus n = 14) were enrolled in the retrospective observational study. Mechanical axis deviation, mechanical lateral distal femoral angle, and mechanical medial proximal tibial angle were assessed prior to surgery and during follow-up. The facultative frontal knee joint line angle (FKJLA) was used as predictive tool. Cases of remaining growth potential (n = 45/78) after implant removal were followed to assess rebound deformity. Pre-operative angles of the mechanical axis were corrected average 9.0 months after HEPD. Pre-operative assessment of the frontal knee joint line revealed a mean of 3.9° in valgus, and -1.0° in varus deformities. At time of complete deformity correction, mean FKJLA was -0.2° in valgus, and -0.8° in varus deformities. Mean shift of FKJLA was significantly higher after singleHEPD compared to combiHEPD (P <.001). Patients having an unphysiological FKJLA (>/<0°-3°) after correction of mechanical axis had a significantly higher risk of rebound deformity (P =.01). Regression analysis showed a 60.5% higher risk of rebound deformity per each degree deviating from the FKJLA physiological range. Age, gender, or body mass index had no impact. Temporary HEPD offers great potential for the correction of the mechanical axis and the frontal knee joint line. An unphysiological change of the frontal knee joint line is associated with a high risk of recurrent angular deformities. CombiHEPD instead of singleHEPD seems to be safer to prevent detrimental frontal knee joint line shift. Level of Evidence: Retrospective comparative therapeutic study, Level III.
AB - Guided growth by temporary hemiepiphysiodesis (HEPD) is established for the alignment of lower limb angular deformities. This retrospective cohort study was designed to assess the effect of HEPD in idiopathic coronal plane deformities around the knee and on the frontal knee joint line orientation, and to test the frontal knee joint line as predictive means for recurrence. Fourty-four patients (78 deformities: valgus n = 64, varus n = 14) were enrolled in the retrospective observational study. Mechanical axis deviation, mechanical lateral distal femoral angle, and mechanical medial proximal tibial angle were assessed prior to surgery and during follow-up. The facultative frontal knee joint line angle (FKJLA) was used as predictive tool. Cases of remaining growth potential (n = 45/78) after implant removal were followed to assess rebound deformity. Pre-operative angles of the mechanical axis were corrected average 9.0 months after HEPD. Pre-operative assessment of the frontal knee joint line revealed a mean of 3.9° in valgus, and -1.0° in varus deformities. At time of complete deformity correction, mean FKJLA was -0.2° in valgus, and -0.8° in varus deformities. Mean shift of FKJLA was significantly higher after singleHEPD compared to combiHEPD (P <.001). Patients having an unphysiological FKJLA (>/<0°-3°) after correction of mechanical axis had a significantly higher risk of rebound deformity (P =.01). Regression analysis showed a 60.5% higher risk of rebound deformity per each degree deviating from the FKJLA physiological range. Age, gender, or body mass index had no impact. Temporary HEPD offers great potential for the correction of the mechanical axis and the frontal knee joint line. An unphysiological change of the frontal knee joint line is associated with a high risk of recurrent angular deformities. CombiHEPD instead of singleHEPD seems to be safer to prevent detrimental frontal knee joint line shift. Level of Evidence: Retrospective comparative therapeutic study, Level III.
UR - http://www.scopus.com/inward/record.url?scp=85123663997&partnerID=8YFLogxK
U2 - 10.1097/MD.0000000000028626
DO - 10.1097/MD.0000000000028626
M3 - Journal articles
C2 - 35060540
AN - SCOPUS:85123663997
SN - 0025-7974
VL - 101
SP - E28626
JO - Medicine (United States)
JF - Medicine (United States)
IS - 3
ER -
