Hemiepiphysiodesis for coronal angular knee deformities: tension-band plate versus percutaneous transphyseal screw
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ORTHOPAEDIC SURGERY
Hemiepiphysiodesis for coronal angular knee deformities: tension‑band plate versus percutaneous transphyseal screw Galina Shapiro1 · Tohar Adato1 · Shai Paz3 · Tareq Shrabaty3 · Lamdan Ron 2 · Naum Simanovsky 3 · Michael Zaidman3 · Vladimir Goldman3 Received: 20 May 2020 / Accepted: 9 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Pediatric coronal plane knee deformities can be treated surgically using hemiepiphysiodesis. The two leading techniques used for hemiepiphysiodesis are: tension-band plates (TBP) and percutaneous transphyseal screws (PETS). We hypothesized that PETS would lead to faster guided correction of angular knee deformities than TBP. Materials and methods A retrospective cohort of 35 patients treated with either TBP or PETS in one medical institution was established. The cohort included both genu varum and genu valgum of both primary and secondary etiologies. We first compared the treatment groups for differences in demographic and malalignment characteristics. Then, we compared the treatment groups for differences in operation-related outcomes, radiological mechanical correction and complication rates. Results We found that the use of PETS, compared to TBP, was associated with a faster implantation surgery and a shorter interval between implantation and removal, i.e., faster correction. Furthermore, PETS were associated with faster correction rates of the mechanical axis deviation, lateral distal femoral angle and medial proximal tibial angle. No significant differences in complication rates were found between the two treatments. Conclusion PETS provided a faster correction of angular knee deformities compared to TBP at similar complication rates. Hence, PETS could be considered a superior technique for hemiepiphysiodesis. Keywords Pediatric · Knee · Hemiepiphysiodesis · Plate · Screw
Introduction Pediatric coronal plane knee deformities are very common. Genu varum or valgum may be physiologic at an early age, mostly requiring observation and reassurance [1–4]. Importantly, even a physiologic deformity may persist with long-term malalignment. On the other hand, these deformities may be secondary to trauma, developmental disorders, dietary deficiency, infection and neoplasia [1, 5]. Persistent malalignment may lead to uneven loading of the articular * Goldman Vladimir [email protected] 1
Medical Corps, Israel Defense Forces, Military Post, 02149 Ramat Gan, Israel
2
Pediatric Orthopedics Unit, Department of Orthopedic Surgery, Assuta Ashdod Medical Center, Ashdod, Israel
3
Pediatric Orthopedics Unit, Department of Orthopedic Surgery, Kyriat Hadassah, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel
cartilage with early-onset arthritis, pain and disability. While novel treatments are being investigated for osteoarthritis [6, 7], prevention remains an attractive therapeutic strategy. Therefore, physiologic malalignment that does not correct spontaneously and pathological
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