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Temporary hemiepiphysiodesis using eight-plates for angular deformities of the lower extremities in children with X-linked hypophosphataemic rickets

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Abstract

Purposes

Temporary hemiepiphysiodesis (TH) using eight-plates is one of the most frequently performed surgeries for correcting angular deformities of the lower extremities in adolescents. Rarely have studies examined children with X-linked hypophosphataemic rickets (X-LHPR) treated with TH using eight-plates. This study was conducted to investigate the efficacy, the endpoint, and the complications of TH using eight-plates to correct angular deformities of the lower extremities in skeletally immature children.

Methods

We reviewed a total of 26 children (86 physes, 52 knees) with X-LHPR (mean age of 6.2 years, range from 2 to 13 years) who underwent TH using eight-plate to correct angular deformities of the lower extremities. Radiographs and clinical records of these patients were evaluated for demographic data and related clinical factors.

Results

The average correction of the mechanical lateral distal femoral angle (mLDFA) was 11.7 ± 8.7° (range from 1.0 to 29.7°), and the average correction of the mechanical medial proximal tibial angle (mMPTA) was 8.4 ± 5.0° (range from 0.3 to 16.7°). The mean deformity correction time was 22.7 months (range from 7 to 60 months), and the mean follow-up after eight-plate removal was 43.9 months (range from 24 to 101 months). Overall, 76.9% (20/26 patients) of the angular deformities of the knee were completely corrected and 15.4% (4/26) of the patients received osteotomy surgery. The femoral correction velocity (0.9° per month) was significantly higher than the proximal tibial (0.6° per month) (p = 0.02). The correction velocity of the mLDFA and mMPTA with the TH procedure was faster than that in the absence of intervention (0.9° vs. 0.2°, 0.7° vs. 0.4° per month, p < 0.05). The correction velocity of the mLDFA (1.2° vs. 0.5° per month, \(p<0.001\)) and mMPTA (0.7° vs. 0.5° per month, p = 0.04) of patients whose age ≤ five years old was faster than that of patients whose age > five years old. A total of 69.2% (18/26) patients experienced one TH procedure using eight-plates only. Two patients had screw loosening (2/26, 7.7%). One patient (1/26, 3.8%) had a rebound phenomenon after the removal of eight-plate and had the TH procedure again. There was no breakage, infection, physis preclosure, or limited range of movement found in the follow-up.

Conclusion

TH using eight-plates is a safe and effective procedure with a relatively low incidence of complication and rebound, and it could be used as part of a streamlined treatment for younger X-LHPR patients with resistant or progressive lower limb deformity despite optimal medical treatment. Early intervention can achieve better results.

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Data availability

The datasets analyzed in this study are available from the corresponding author upon reasonable request.

Code availability

Not applicable.

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Funding

This work was supported by High-level Hospital Construction Research Project of Maoming People’s Hospital, and Maoming Science and Technology Project (2022166).

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Author notes

  1. Wei-Jia Feng and Zhen-Zhen Dai contributed equally.

Authors and Affiliations

  1. Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Wei-Jia Feng, Zhen-Zhen Dai & Zhen-Kai Wu

  2. Department of Orthopedics, Maoming People’s Hospital, Maoming, Guangdong, China

    Qing-Guang Xiong

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  1. Wei-Jia Feng
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Contributions

All authors participated in the design, interpretation of the studies, and analysis of the data and review of the manuscript. Feng WJ and Wu ZK did the design of the study; Xiong QG, Dai ZZ, and Feng WJ reviewed the patients and analyzed the data; Feng WJ and Wu ZK wrote the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Qing-Guang Xiong or Zhen-Kai Wu.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Approval number: XHEC-D-2022–192).

Consent to participate

Written informed consent was obtained from the parents.

Consent for publication

The authors affirm that human research participants provided informed consent for publication of the images in Figs. 2, 3, and 4.

Competing interests

Financial interests: Feng WJ, Dai ZZ, and Wu ZK declare they have no financial interests. Xiong QG has received research funding from High-level Hospital Construction Research Project of Maoming People’s Hospital and Maoming Science and Technology Project (2022166).

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Feng, WJ., Dai, ZZ., Xiong, QG. et al. Temporary hemiepiphysiodesis using eight-plates for angular deformities of the lower extremities in children with X-linked hypophosphataemic rickets. International Orthopaedics (SICOT) 47, 763–771 (2023). https://doi.org/10.1007/s00264-023-05688-y

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