Highlights
- •Temporary hemiepiphysiodesis is an effective procedure to treat genu valgum.
- •Incorrect timing or indications could compromise the outcomes.
- •Patients undergoing surgery should be minimum 8 years old.
- •An IMD > 8 cm and a mLDFA < 87° are shared threshold values to consider surgery.
- •Postoperative evaluation should be scheduled every 3–6 months.
Abstract
Introduction
Temporary isolated medial femoral hemiepiphysiodesis (TIMFH) represents a safe and
effective technique widely used to treat idiopathic genu valgum. Recent studies mainly
concentrated on comparing outcomes of different implants, while less attention has
been reserved to the proper indications and timing for surgery. The aim of this systematic
review was to provide evidence-based guidelines about indications for device implant
and removal and postoperative management.
Methods
A comprehensive literature search was performed across three databases to select articles
concerning TIMFH in the treatment of idiopathic genu valgum. Studies involving other
etiologies or concomitant surgical procedures were excluded. Quality assessment of
the included studies was conducted through the Newcastle-Ottawa Scale.
Results
Ten studies involving 237 patients for a total of 446 knees were included in the analysis.
Mean age at surgery was 11,4 years. Patients were considered for surgery using various
clinical and radiological parameters. Intermalleolar distance (IMD) and mechanical
lateral distal femoral angle (mLDFA) were the most common evaluated. Mean treatment
time was 12 months. Rebound of the deformity occurred in 6,7% of cases.
Conclusion
Results of this review showed good consensus among authors. Patients undergoing TIMFH
for IGV should be minimum 8 years old, with an IMD greater than 8 cm and a mLDFA lower
than 87°. Postoperative management should comprise of quarterly clinic evaluations,
and follow-up should last until skeletal maturity. The application of more uniform
parameters in clinical practice may improve the establishment of the optimal timing
for implant removal.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The KneeAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Genu valgum in children: diagnostic and therapeutic alternatives.JAAOS-Journal Am Acad Orthop Surg. 1995; 3: 275-283
- The development of the tibiofemoral angle in children.J Bone Jt Surg - Ser A. 1975; 57: 259-261https://doi.org/10.2106/00004623-197557020-00021
- Temporary epiphysiodesis with Blount stapling for treatment of idiopathic genua valga in children.Acta Orthop Belg. 2003; 69: 426-432
Patel M NR. Genu Valgum. Treasure Island (FL): 2021. https://doi.org/PMID: 32644670.
- Guided growth for angular correction: a preliminary series using a tension band plate.J Pediatr Orthop. 2007; 27: 253-259https://doi.org/10.1097/BPO.0b013e31803433a1
- Epiphyseal stapling for angular deformity at the knee.J Bone Joint Surg Am. 1979; 61: 320-329
- Control of bone growth by epiphyseal stapling; a preliminary report.J Bone Joint Surg Am. 1949; 31A: 464-478
- Percutaneous epiphysiodesis using transphyseal screws (PETS).J Pediatr Orthop. 1998; 18: 363-369
- Early experience with medial femoral tension band plating in idiopathic genu valgum.J Child Orthop. 2011; 5: 11-17https://doi.org/10.1007/s11832-010-0310-6
- Temporary hemiepiphysiodesis for idiopathic genua valga in adolescents: Percutaneous transphyseal screws (PETS) versus stapling.J Pediatr Orthop. 2008; 28: 549-554https://doi.org/10.1097/BPO.0b013e31817baab2
- Temporary hemiepiphyseal arrest using a screw and plate device to treat knee and ankle deformities in children: a preliminary report.J Child Orthop. 2008; 2: 187-197https://doi.org/10.1007/s11832-008-0096-y
- Multiplier method may be unreliable to predict the timing of temporary hemiepiphysiodesis for coronal angular deformity.J Orthop Surg Res. 2017; 12: 1-7
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLoS Med. 2009; : 6https://doi.org/10.1371/JOURNAL.PMED.1000097
- Distal femoral hemiepiphysiodesis using screw and non-absorbable filament for the treatment of idiopathic genu valgum. Preliminary results of 12 knees.Orthop Traumatol Surg Res. 2017; 103: 269-273https://doi.org/10.1016/j.otsr.2016.11.014
- Distal femoral hemiepiphysiodesis with screws and suture versus 8-plate for the treatment of genu valgum in children.Orthop Traumatol Surg Res. 2019; 105: 751-755https://doi.org/10.1016/j.otsr.2019.02.019
- Hemiepiphysiodesis for Idiopathic Genu Valgum: Percutaneous Transphyseal Screw Versus Tension-band Plate.J Pediatr Orthop. 2016; 38: 325-330https://doi.org/10.1097/BPO.0000000000000821
- Efficacy of Percutaneous Retrograde Transphyseal Guided Growth Screw in Distal Femoral Angular Deformity Correction: A New Technique.J Pediatr Orthop. 2021; 41: E533-E539https://doi.org/10.1097/BPO.0000000000001835
- Percutaneous hemi-epiphysiodesis using transphyseal cannulated screws for genu valgum in adolescents.J Child Orthop. 2009; 3: 397-403https://doi.org/10.1007/s11832-009-0203-8
- Hemiepiphysiodesis: similar treatment time for tension-band plating and for stapling: a randomized clinical trial on guided growth for idiopathic genu valgum.Acta Orthop. 2013; 84: 202-206https://doi.org/10.3109/17453674.2013.782526
- Guided growth: novel applications in the hip, knee, and ankle.J Pediatr Orthop. 2017; 37: S32-S36
- Outcomes of Hemiepiphyseal Stapling for Genu Valgum Deformities in Patients with Multiple Hereditary Exostoses: A Comparative Study of Patients with Deformities of Idiopathic Cause.J Pediatr Orthop. 2017; 37: 265-271https://doi.org/10.1097/BPO.0000000000000628
- Prevalence of genu valgum in public elementary schools in the city of santos (SP).BRAZIL Rev Paul Pediatr. 2017; 35: 443-447https://doi.org/10.1590/1984-0462/;2017;35;4;00002
- Prevalence of musculoskeletal normal variations of the lower limbs in pediatric orthopedic clinic.Saudi Med J. 2019; 40: 930-935https://doi.org/10.15537/SMJ.2019.9.24478
- Idiopathic Genu Valgum and Its Association With Obesity in Children and Adolescents.J Pediatr Orthop. 2019; 39: 347-352https://doi.org/10.1097/BPO.0000000000000971
- Systematic Review Study of The Using of “Guided Growth” For Correction of Coronal Deformities Around The Knee in Skeletal Immature Children.Benha Med J. 2020; 37: 382-390
- Anterior distal femoral hemiepiphysiodesis in children with cerebral palsy: Establishing surgical indications and techniques using the modified Delphi method and literature review.J Child Orthop. 2022; 16: 65-74https://doi.org/10.1177/18632521221087529
- Radiographic atlas of skeletal development of the hand and wrist.Stanford University Press, 1959
- The correction of genu valgum by epiphysial stapling.J Bone Joint Surg Br. 1977; 59: 72-76https://doi.org/10.1302/0301-620X.59B1.845231
- Treatment of genu valgum in children by means of temporary hemiepiphysiodesis using eight-plates: short-term findings.BMC Musculoskelet Disord. 2017; 18: 456https://doi.org/10.1186/s12891-017-1823-7
- Temporary hemiepiphysiodesis using an eight-plate implant for coronal angular deformity around the knee in children aged less than 10 years: efficacy, complications, occurrence of rebound and risk factors.BMC Musculoskelet Disord. 2021; 22: 53https://doi.org/10.1186/s12891-020-03915-w
- Genu Valgum.Essent Orthop Rev Quest Answers Sr Med Students. 2022; : 299-300https://doi.org/10.1007/978-3-319-78387-1_131
- Prediction of rebound phenomenon after removal of hemiepiphyseal staples in patients with idiopathic genu valgum deformity.Bone Jt J. 2016; https://doi.org/10.1302/0301-620X.98B9.37260
Article info
Publication history
Published online: November 18, 2022
Accepted:
November 3,
2022
Received in revised form:
September 16,
2022
Received:
June 14,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
