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Percutaneous epiphysiodesis using transphyseal screws (PETS) versus tension-band plating (TBP): comparative study of outcomes for correcting limb length discrepancy

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objectives

The best effective treatment strategy for limb length discrepancy (LLD) is still being debated. The goal of this study was to compare the efficacy and results of tension-band plating (TBP) and percutaneous epiphysiodesis using transphyseal screws (PETS) for LLD correction.

Methods

From June 2008 to January 2019, children who had lower extremity epiphysiodesis with either TBP or PETS were reviewed retrospectively. At the conclusion of treatment, LLD, angular deformity, and complications were reviewed. The t-test or Wilcoxon rank sum test was used to compare continuous variables. Categorical variables were evaluated using Fisher’s exact test or χ2 test.

Results

A total of 32 epiphysiodeses with TBP (14 patients, 24 femur/tibias) or PETS (13 patients, 23 femur/tibias) were compared. TBPs were conducted while the patients were younger (11.0 vs. 13.1 years, p = 0.005). The treatment durations were similar in both groups (TBP: 23.5 months vs. PETS: 24 months, p = 0.132). PETS had significantly shorter operative time (p = 0.047), length of hospital stay (p = 0.014), and time to return to full activity (p = 0.043). LLD in the TBP group reduced from 2.64 to 1.38 cm (p = 0.005), while in the PETS group it decreased from 2.76 to 1.08 cm (p = 0.001). During treatment, the rate of LLD correction was 0.49 ± 0.9 cm/year for limbs treated with TBP and 1.0 ± 1.1 cm/year for limbs treated with PETS (p = 0.185). At the end of treatment, 8 TBP cases (47%) and 9 PETS cases (60%) had achieved LLD ≤ 2 cm (p = 0.502), and at the most recent follow-up, this had grown to 11 (65%) in the TBP group and 12 (80%) in the PETS group. There were no significant differences in the total number of complications between groups (p > 0.05). Revision surgery was required in 11 TBP and 3 PETS limbs due to persistent LLD or angular deformity (AD) (p = 0.016). Logistic regression did not reveal any significant association between TBP and the rate of complication or revision surgery.

Conclusion

PETS and TBP are both effective methods for limb length equalization. PETS, on the other hand, was linked to a shorter operative time, a shorter hospital stay, a faster recovery to pre-operative function, and a lower complication rate. The rate of revision surgery due to persistent LLD or AD was higher in TBP. We advise surgeons against utilizing TBP to correct LLD.

Level of evidence

III.

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Funding

No funding was received.

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Author notes

  1. Manaf H. Younis and Regina Hanstein have contributed equally to this work.

Authors and Affiliations

  1. Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY, USA

    Manaf H. Younis, Regina Hanstein, Eric D. Fornari, Jaime A. Gomez, Melinda S. Sharkey & Jacob F. Schulz

  2. Albert Einstein College of Medicine, Bronx, NY, USA

    Kainaat Javed

Authors
  1. Manaf H. Younis
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  2. Regina Hanstein
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  3. Kainaat Javed
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  4. Eric D. Fornari
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  5. Jaime A. Gomez
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  6. Melinda S. Sharkey
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  7. Jacob F. Schulz
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Contributions

MY, Design; Data acquisition; analysis; Interpretation of data; Drafting and critical revision; Final approval of submission. RH, Design; Data acquisition; analysis; Interpretation of data; Drafting and critical revision; Final approval of submission. KJ, Data acquisition; Drafting and critical revision; Final approval of submission. EF, Interpretation of data; Drafting and critical revision; Final approval of submission. JG, Interpretation of data; Drafting and critical revision; Final approval of submission. MS, Interpretation of data; Drafting and critical revision; Final approval of submission. JS, Design; Interpretation of data; Drafting and critical revision; Final approval of submission.

Corresponding author

Correspondence to Manaf H. Younis.

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Conflict of interest

MHY, RH, KJ, EDF, MSS and JFS declare that they have no conflict of interest. JAG reports a consultancy and honoraria with Stryker Spine outside the submitted work.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Younis, M.H., Hanstein, R., Javed, K. et al. Percutaneous epiphysiodesis using transphyseal screws (PETS) versus tension-band plating (TBP): comparative study of outcomes for correcting limb length discrepancy. Eur J Orthop Surg Traumatol 33, 1523–1531 (2023). https://doi.org/10.1007/s00590-022-03304-0

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  • DOI: https://doi.org/10.1007/s00590-022-03304-0

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