Abstract
Background
Percutaneous epiphysiodesis using transphyseal screws (PETS) has been associated with implant failure, implant prominence, angular deformities, and delayed growth inhibition.
Questions/Purposes
The aim of this study was to assess the complication rate and efficacy (defined as actual growth inhibition divided by expected growth inhibition) of PETS and to identify factors associated with improved efficacy.
Methods
Patients who underwent distal femoral and/or proximal tibial PETS between January 2007 and June 2014 were identified. Complications, efficacy, and final limb-length discrepancy (LLD) were calculated using multipliers and inhibition rates based on previous growth. Associations between efficacy and screw insertion angle (SIA), body mass index, and number of threads crossing the physis were calculated.
Results
Eight-two patients (126 treated physes) were included. The mean pre-operative LLD was 27.7 mm (SD = 7.5). Following epiphysiodesis, 15 had temporary pain (18%), five had temporary effusion (6.1%), four had broken implants (4.9%), four developed mild angulation (4.9%), and three had failed epiphysiodesis requiring revision (3.7%). Thirty-one underwent screw removal (n = 31, 38%). Mean LLD at maturity was 17.3 mm (SD = 5.8 mm). Mean efficacy at the distal femur was 97% (SD = 46%), at the proximal tibia was 108% (SD = 66%) and was 103% (SD = 57%) overall. Increased screw threads across the lateral proximal tibial physis (Spearman’s correlation coefficient = 0.67; 95% CI = 0.40–0.94) and higher BMI (Spearman’s correlation coefficient = 0.55; 95% CI = 0.34–0.77) were positively associated with increased efficacy.
Conclusions
The efficacy of PETS may be more favorable than previously reported. Only 3.7% had serious complications requiring revision epiphysiodesis, lower than previous reports. Attention to sufficient screw threads across the physis may be important in optimizing PETS results.
Similar content being viewed by others
References
Babu LV, Evans O, Sankar A, et al. Epiphysiodesis for limb length discrepancy: a comparison of two methods. Strategies Trauma Limb Reconstr. 2014; 9: 1-3. doi:10.1007/s11751-013-0180-9.
Bowen JR, Johnson WJ (1984) Percutaneous epiphysiodesis. Clin Orthop Relat Res 170–3.
Bylski-Austrow DI, Wall EJ, Rupert MP, Roy DR, Crawford AH Growth plate forces in the adolescent human knee: a radiographic and mechanical study of epiphyseal staples. J Pediatr Orthop 21:817–23.
Campens C, Mousny M, Docquier P-L. Comparison of three surgical epiphysiodesis techniques for the treatment of lower limb length discrepancy. Acta Orthop Belg. 2010; 76: 226-32.
ST, Christian CA (1990) Techniques for epiphysiodesis about the knee. Clin Orthop Relat Res 81–5.
Chaumoitre K, Lamtali S, Baali A, et al. Influence of socioeconomic status and body mass index on bone age. Horm Res pædiatrics. 2010; 74: 129-35. doi:10.1159/000313371.
Dodwell ER, Widmann RF (2015) Percutaneous distal femoral or proximal tibial epiphysiodesis for leg length discrepancy. Oper. Tech. Pediatr. Orthop.
Escott BG, Ravi B, Weathermon AC, et al. EOS low-dose radiography: a reliable and accurate upright assessment of lower-limb lengths. J Bone Joint Surg Am. 2013; 95: e1831-7. doi:10.2106/JBJS.L.00989.
Ghanem I, Karam JA, Widmann RF. Surgical epiphysiodesis indications and techniques: update. Curr Opin Pediatr. 2011; 23: 53-9. doi:10.1097/MOP.0b013e32834231b3.
Golightly YM, Allen KD, Renner JB, et al. Relationship of limb length inequality with radiographic knee and hip osteoarthritis. Osteoarthr Cartil. 2007; 15: 824-9. doi:10.1016/j.joca.2007.01.009.
Greulich W, Pyle S. Radiographic atlas of skeletal development of the hand and wrist. 2nd ed. Redwood City, CA: Stanford University Press; 1959.
Gross RH. Leg length discrepancy: how much is too much? Orthopedics. 1978; 1: 307-10.
Heflin JA, Ford S, Stevens P. Guided growth for tibia vara (Blount’s disease). Medicine (Baltimore). 2016; 95: e4951. doi:10.1097/MD.0000000000004951.
Ilharreborde B, Gaumetou E, Souchet P, et al. Efficacy and late complications of percutaneous epiphysiodesis with transphyseal screws. J Bone Joint Surg Br. 2012; 94: 270-5. doi:10.1302/0301-620X.94B2.27470.
Khoury JG, Tavares JO, McConnell S, et al. Results of screw epiphysiodesis for the treatment of limb length discrepancy and angular deformity. J Pediatr Orthop. 2007; 27: 623-8. doi:10.1097/BPO.0b013e318093f4f4.
Métaizeau JP, Wong-Chung J, Bertrand H, et al. Percutaneous epiphysiodesis using transphyseal screws (PETS). J Pediatr Orthop. 1998; 18: 363-9.
Monier BC, Aronsson DD, Sun M. Percutaneous epiphysiodesis using transphyseal screws for limb-length discrepancies: high variability among growth predictor models. J Child Orthop. 2015; 9: 403-410. doi:10.1007/s11832-015-0687-3.
Nouth F, Kuo LA. Percutaneous epiphysiodesis using transphyseal screws (PETS): prospective case study and review. J Pediatr Orthop. 2004; 24: 721-5.
Ogilvie JW, King K. Epiphysiodesis: two-year clinical results using a new technique. J Pediatr Orthop. 1990; 10: 809-11.
Paley D, Bhave A, Herzenberg JE, et al. Multiplier method for predicting limb-length discrepancy. J Bone Joint Surg Am. 2000; 82–A: 1432-46.
Paley D. Principles of Deformity Correction. 1st ed. Berlin, Germany: Spring; 2003.
Song KM, Halliday SE, Little DG. The effect of limb-length discrepancy on gait. J Bone Joint Surg Am. 1997; 79: 1690-8.
Song MH, Choi E-S, Park MS, et al. Percutaneous epiphysiodesis using transphyseal screws in the management of leg length discrepancy: optimal operation timing and techniques to avoid complications. J Pediatr Orthop. 2015; 35: 89-93. doi:10.1097/BPO.0000000000000214.
Song MH, Park MS, Yoo WJ, Chung CY, Choi IH, Cho TJ (2013) Effects and complications of percutaneous epiphysiodesis using transphyseal screws in the management of leg length discrepancy. Int. Fed. Paediatr. Orthop. Soc. Meet.
Stanitski DF Limb-length inequality: assessment and treatment options. J Am Acad Orthop Surg 7:143–53.
Upasani V, Kishan S, Oka R, et al. Biomechanical Analysis of Single Screw Fixation for Slipped Capital Femoral Epiphysis. J Pediatr Orthop. 2006; 26: 474-478. doi:10.1097/01.bpo.0000217732.24041.81.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Emily R. Dodwell, MD, MPH, FRCSC; Matthew R. Garner, MD; Elise Bixby, BA; Eva M. Luderowski, BA; Daniel W. Green, MD; John S. Blanco, MD; and Roger F. Widmann, MD, have declared that they have no conflict of interest.
Human/Animal Rights
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed Consent
Informed consent was obtained from all patients for being included in the study.
Funding
This research was funded through the Hospital for Special Surgery Pediatric Council Grant and the HSS Medical Student Summer Research Fellowship Program.
Required Author Forms
Disclosure forms provided by the authors are available with the online version of this article.
Additional information
Level of Evidence: Therapeutic Level IV
Rights and permissions
About this article
Cite this article
Dodwell, E.R., Garner, M.R., Bixby, E. et al. Percutaneous Epiphysiodesis Using Transphyseal Screws: a Case Series Demonstrating High Efficacy. HSS Jrnl 13, 255–262 (2017). https://doi.org/10.1007/s11420-017-9549-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11420-017-9549-5