Document Detail


Treatment of adolescent tibia vara with hemiepiphysiodesis: risk factors for failure.
MedLine Citation:
PMID:  19952250     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Lateral tibial hemiepiphysiodesis is an accepted surgical treatment for skeletally immature patients with adolescent tibia vara. However, the results of this procedure are unpredictable. This study was conducted to identify the risk factors associated with failure of hemiepiphysiodesis. METHODS: We studied patients with adolescent tibia vara who were at least ten years of age, had open physes, had been treated with a lateral hemiepiphysiodesis, and had been followed for at least two years. The mechanical axis deviation, medial proximal tibial angle, and lateral distal femoral angle were measured on radiographs preoperatively, at six months postoperatively, and at the time of final follow-up. Failure was defined as a residual varus deformity requiring osteotomy or a mechanical axis deviation exceeding 40 mm (moderate or severe varus) at the time of final follow-up. RESULTS: Forty-nine patients (forty-six male) with a total of sixty-four involved extremities met the inclusion criteria. The average age was 13.4 years, the average body mass index was 40.7 kg/m(2), and the average duration of follow-up was 3.3 years. The lateral hemiepiphysiodesis was unsuccessful in 66% of the patients. In a multivariate Cox proportional hazards regression analysis, the variables associated with a higher risk of failure included an age of fourteen years or more (hazard ratio = 3.9, p = 0.0009) and a body mass index of > or =45 kg/m(2) (hazard ratio = 2.8, p = 0.01). Greater deformity at baseline as indicated by a smaller medial proximal tibial angle was also found to be a significant factor in the multivariate analysis (p = 0.03). CONCLUSIONS: Lateral hemiepiphysiodesis may be a valuable treatment option for non-morbidly obese patients with less severe adolescent tibia vara, but it is likely to fail in older adolescents with a high body mass index and greater deformity.
Authors:
Amy L McIntosh; Chad M Hanson; Karl E Rathjen
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of bone and joint surgery. American volume     Volume:  91     ISSN:  1535-1386     ISO Abbreviation:  J Bone Joint Surg Am     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-02     Completed Date:  2009-12-22     Revised Date:  2010-10-25    
Medline Journal Info:
Nlm Unique ID:  0014030     Medline TA:  J Bone Joint Surg Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2873-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Bone Diseases, Developmental / surgery*
Child
Female
Humans
Male
Orthopedic Procedures / methods*
Retrospective Studies
Risk Factors
Tibia / surgery*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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