Hemiepiphysiodesis for Genu Valgum in Patients With Multiple Hereditary Exostoses.
Journal
Journal of pediatric orthopedics
ISSN: 1539-2570
Titre abrégé: J Pediatr Orthop
Pays: United States
ID NLM: 8109053
Informations de publication
Date de publication:
07 Mar 2024
07 Mar 2024
Historique:
medline:
7
3
2024
pubmed:
7
3
2024
entrez:
7
3
2024
Statut:
aheadofprint
Résumé
Genu valgum is a well-known feature of multiple hereditary exostoses (MHE). Though prior reports have demonstrated successful treatment with hemiepiphysiodesis, details regarding the correction rate and comparison to an idiopathic population are lacking. This study aimed to detail our institution's experience with guided growth of the knee in patients with MHE and compare this to an idiopathic population. All pediatric patients (age 18 and younger) with MHE who underwent lower extremity hemiepiphysiodesis at a tertiary care medical center between January 2016 and December 2022 were retrospectively reviewed. Preoperative and postoperative mechanical lateral distal femoral angle (mLDFA) and medial proximal tibial angle (MPTA, the primary outcomes) were measured in addition to mechanical axis deviation (MAD) and hip-knee-ankle angle (HKA). Patients were 1:2 matched based on age, sex, and physes instrumented to a cohort with idiopathic genu valgum. A total of 21 extremities in 16 patients with MHE underwent hemiepiphysiodesis of the distal femur, proximal tibia, and/or distal tibia. The mean age at surgery was 11.7±2.2 years. Mean MAD corrected from zone 1.9±0.7 to -0.3±1.5, while mLDFA corrected from 83.4±2.9 to 91.7±5.2 degrees and MPTA corrected from 95.3±3.6 to 90.5±4.0 degrees in distal femurs and proximal tibias undergoing guided growth, respectively. Three extremities (14.3%) experienced overcorrection ≥5 degrees managed with observation. There were no differences in correction rates per month for mLDFA (0.54±0.34 vs. 0.51±0.29 degrees, P=0.738) or MPTA (0.31±0.26 vs. 0.50±0.59 degrees, P=0.453) between MHE and idiopathic groups. For 11 extremities in the MHE group with open physes at hardware removal, they experienced a mean recurrence of HKA of 4.0±3.4 degrees at 19-month follow-up. Hemiepiphysiodesis corrects lower extremity malalignment in patients with MHE at a similar rate compared with an idiopathic coronal plane deformity population. Rebound deformity of 4 degrees at 19 months after hardware removal in patients with remaining open growth plates should make surgeons conscious of the remaining growth potential when planning deformity correction. Level III.
Sections du résumé
BACKGROUND
BACKGROUND
Genu valgum is a well-known feature of multiple hereditary exostoses (MHE). Though prior reports have demonstrated successful treatment with hemiepiphysiodesis, details regarding the correction rate and comparison to an idiopathic population are lacking. This study aimed to detail our institution's experience with guided growth of the knee in patients with MHE and compare this to an idiopathic population.
METHODS
METHODS
All pediatric patients (age 18 and younger) with MHE who underwent lower extremity hemiepiphysiodesis at a tertiary care medical center between January 2016 and December 2022 were retrospectively reviewed. Preoperative and postoperative mechanical lateral distal femoral angle (mLDFA) and medial proximal tibial angle (MPTA, the primary outcomes) were measured in addition to mechanical axis deviation (MAD) and hip-knee-ankle angle (HKA). Patients were 1:2 matched based on age, sex, and physes instrumented to a cohort with idiopathic genu valgum.
RESULTS
RESULTS
A total of 21 extremities in 16 patients with MHE underwent hemiepiphysiodesis of the distal femur, proximal tibia, and/or distal tibia. The mean age at surgery was 11.7±2.2 years. Mean MAD corrected from zone 1.9±0.7 to -0.3±1.5, while mLDFA corrected from 83.4±2.9 to 91.7±5.2 degrees and MPTA corrected from 95.3±3.6 to 90.5±4.0 degrees in distal femurs and proximal tibias undergoing guided growth, respectively. Three extremities (14.3%) experienced overcorrection ≥5 degrees managed with observation. There were no differences in correction rates per month for mLDFA (0.54±0.34 vs. 0.51±0.29 degrees, P=0.738) or MPTA (0.31±0.26 vs. 0.50±0.59 degrees, P=0.453) between MHE and idiopathic groups. For 11 extremities in the MHE group with open physes at hardware removal, they experienced a mean recurrence of HKA of 4.0±3.4 degrees at 19-month follow-up.
CONCLUSION
CONCLUSIONS
Hemiepiphysiodesis corrects lower extremity malalignment in patients with MHE at a similar rate compared with an idiopathic coronal plane deformity population. Rebound deformity of 4 degrees at 19 months after hardware removal in patients with remaining open growth plates should make surgeons conscious of the remaining growth potential when planning deformity correction.
LEVEL OF EVIDENCE
METHODS
Level III.
Identifiants
pubmed: 38450657
doi: 10.1097/BPO.0000000000002654
pii: 01241398-990000000-00501
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
D.W.G. has royalties in Arthrex Inc. and Pega Medical. D.W.G. is a consultant for Arthrex Inc. R.F.W. is a consultant for SpineGuard Co. And is on the editorial board for Children’s Orthopaedics and Spinal Deformity. E.R.D. is an Orthopediatrics consultant and an AAOS official spokesperson. The remaining authors declare no conflicts of interest.
Références
Schmale GA, Conrad EU III, Raskind WH. The natural history of hereditary multiple exostoses. J Bone Joint Surg Am. 1994;76:986–992.
Madoki A, Tuerlinckx C, Rausin G, et al. Lower limb deformities and limb length discrepancies in hereditary multiple exostoses. Acta Orthop Belg. 2022;88:198–205.
Mordenti M, Gnoli M, Boarini M, et al. The Rizzoli Multiple Osteochondromas Classification revised: describing the phenotype to improve clinical practice. Am J Med Genet A. 2021;185:3466–3475.
Mordenti M, Shih F, Boarini M, et al. The natural history of multiple osteochondromas in a large Italian cohort of pediatric patients. Bone. 2020;139:115499. Epub 2020 Jun 24. PMID: 32592948.
Hung TY, Wu KW, Lee CC, et al. Guided growth improves coxa valga and hip subluxation in children with hereditary multiple exostoses. J Pediatr Orthop. 2023;43:e67–e73.
Aitchison AH, Alcoloumbre D, Belzarena AC, et al. Rapidly acquired valgus deformity of the knee after osteochondroma resection in multiple hereditary exostoses pediatric patients: a report of two cases. Radiol Case Rep. 2022;17:201–207.
van Oosterbos M, van der Zwan AL, van der Woude HJ, et al. Correction of ankle valgus by hemiepiphysiodesis using the tension band principle in patients with multiple hereditary exostosis. J Child Orthop. 2016;10:267–273.
Kang S, Kim JY, Park SS. Outcomes of hemiepiphyseal stapling for genu valgum deformities in patients with multiple hereditary exostoses: a comparative study of patients with deformities of idiopathic cause. J Pediatr Orthop. 2017;37:265–271.
Trisolino G, Boarini M, Mordenti M, et al. Outcomes of temporary hemiepiphyseal stapling for correcting genu valgum in children with multiple osteochondromas: a single institution study. Children. 2021;8:287.
Mielke CH, Stevens PM. Hemiepiphyseal stapling for knee deformities in children younger than 10 years: a preliminary report. J Pediatr Orthop. 1996;16:423–429.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174.
Birch JG, Makarov MA, Jackson TJ, et al. Comparison of Anderson-Green growth-remaining graphs and white-menelaus predictions of growth remaining in the distal femoral and proximal tibial physes. J Bone Joint Surg Am. 2019;101:1016–1022.
Denduluri SK, Lu M, Bielski RJ. Development of genu valgum after removal of osteochondromas from the proximal tibia. J Pediatr Orthop B. 2016;25:582–586.
Gornitzky AL, Schaeffer EK, Price CT, et al; International Hip Dysplasia Institute. Pavlik Harness disease revisited: does prolonged treatment of a dislocated hip in a harness adversely affect the α angle? J Pediatr Orthop. 2018;38:297–304.