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Percutaneous Epiphysiodesis Using Transphyseal Screws: a Case Series Demonstrating High Efficacy

  • Original Article
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HSS Journal ®

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.

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Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Emily R. Dodwell MD, MPH, FRCSC, Eva M. Luderowski BA, Daniel W. Green MD, John S. Blanco MD & Roger F. Widmann MD

  2. Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, 17033, USA

    Matthew R. Garner MD

  3. College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA

    Elise Bixby BA

Authors
  1. Emily R. Dodwell MD, MPH, FRCSC
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  2. Matthew R. Garner MD
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  3. Elise Bixby BA
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  4. Eva M. Luderowski BA
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  5. Daniel W. Green MD
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  6. John S. Blanco MD
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  7. Roger F. Widmann MD
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Corresponding author

Correspondence to Emily R. Dodwell MD, MPH, FRCSC.

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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.

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Additional information

Level of Evidence: Therapeutic Level IV

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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

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  • DOI: https://doi.org/10.1007/s11420-017-9549-5

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