The Efficacy of Percutaneous Lateral Hemiepiphysiodesis on Angular Correction in Idiopathic Adolescent Genu Varum

BACKGROUND: Percutaneous lateral hemiepiphysiodesis of the lower extremity is a simple and excellent method to correct the angular and length problems cosmetically. However, the efficacy of percutaneous lateral hemiepiphysiodesis is not well established in the literature. The purpose of this study was to evaluate the efficacy of percutaneous lateral hemiepiphysiodesis for angular corrections in adolescent idiopathic genu varum patients with proximal tibia vara and identify the factors affecting the amount of deformity correction of the lower limb in the coronal plane. METHODS: We retrospectively reviewed 20 patients (40 lower limbs) who had percutaneous lateral hemiepiphysiodesis on the proximal lateral tibia between 1997 and 2010. Radiographic evaluations were made using (1) the hip-knee-ankle angle and (2) the length of the tibia. Furthermore, the intercondylar distance was evaluated at the level of the knee joint. Preoperative factors (gender, age, body mass index, intercondylar distance, preoperative hip-knee-ankle angle, remaining growth of tibia, and calculated correctable angle) were analyzed, as well as their correlation with the degree of the actual correction angle. RESULTS: The amount of coronal deformity of the lower limb was improved from its preoperative state. The median average of hip-knee-ankle angle improved from 8.0degrees (interquartile range [IQR], 7.0degrees to 10.0degrees) preoperatively to 3.0degrees (IQR, 2.5degrees to 4.0degrees) at the final follow-up (p < 0.001). The median percent ratio of the angular correction was 60% (IQR, 50% to 71.3%). The correlation coefficients were -0.537, 0.832, 0.791, and 0.685 for the bone age, preoperative hip-knee-ankle angle, the remaining growth of tibia, and calculated correctable angle, respectively. CONCLUSIONS: Despite the excellent cosmetic outcome of percutaneous lateral hemiepiphysiodesis on the proximal lateral tibia in adolescent idiopathic genu varum, the effect was limited in most cases. For optimum results, surgery a few months earlier is recommended, rather than at the calculated operation time.

Osteotomía valguizante de tibia proximal en el tratamiento del genu varo artrósico / Valgus Osteotomy of the Proximal Tibia in the Treatment of Arthritic Genu varo

Fundamento: la asimilación de fuerzas en una rodilla mal alineada implica dolor, deformidad y disminución del rango de movimiento. La corrección quirúrgica retarda la progresión de la afección degenerativa articular y la realización de una artroplastia total. Objetivo: evaluar los resultados de la osteotomía valguizante de tibia proximal en el tratamiento del genu varo artrósico. Métodos: estudio descriptivo sobre 21 pacientes atendidos en el Servicio de Ortopedia del Hospital Territorial Docente Julio Aristegui Villamil, entre enero del 2003 y septiembre del 2008, con el diagnóstico de gonartrosis del compartimiento medial y deformidad angular vara secundaria, a los que se les realizó una osteotomía valguizante de tibia proximal con el uso de fijador externo RALCA®. Resultados: predominaron los pacientes masculinos (71,4 %), con edad media de 56,3±2,01 años, el sobrepeso como factor predisponente (57, 1 %) y 52,3 % de lesiones grado II según criterios de Ahlback. Desde el posoperatorio inmediato hasta los dos años, se logró un promedio de corrección quirúrgica del eje femorotibial de 9±1, 13 grados, con una pérdida de corrección de 2 ± 0,34 grados. La osteítis del alambre fue la complicación más frecuente (19, 04 %). A los dos años de evolución los resultados eran buenos en el 80,9 % de los casos. Se retrasó la artroplastia total o parcial de rodilla, disminuyó el dolor, mejoró la capacidad funcional y la calidad de vida en el 95, 2 % de los pacientes. Conclusiones: la osteotomía valguizante de tibia proximal resultó efectiva en el tratamiento del genu varo artrósico.

Background: the assimilation of forces in a misaligned knee involves pain, deformity and decreased range of motion. Surgical correction delays the progression of degenerative joint affection and the performance of a total arthroplasty. Objective: To assess the results of valgus osteotomy of the proximal tibia in the treatment of arthritic genu varo. Methods: A descriptive study was conducted including 21 patients treated at the Orthopedics Service of the Julio Aristegui Villamil Teaching Territorial Hospital from January 2003 to September 2008, with the diagnosis of medial compartment knee osteoarthritis and angular deformity in the secondary rod. These patients underwent valgus osteotomy of the proximal tibia using an external fixator RALCA ®. Results: Male patients predominated (71.4%) with an average age of 56.3 ± 2.01 years old, as well as overweight as a predisposing factor (57, 1%) and 52.3% of grade II lesions according to Ahlback criteria . From the immediate postoperative period up to two years of evolution, we achieved an average femorotibial axis surgical correction of 9 ± 1.13 degrees, with a loss of correction of 2 ± 0.34 degrees. Wire osteitis was the most common complication (19, 04%). After two years of evolution the results were good in 80.9% of cases: partial or total arthroplasty of the knee was delayed, pain was reduced and functional capacities as well as life quality of patients were improved in 95, 2% of cases. Conclusions: Valgus osteotomy of the proximal tibia was effective in the treatment of arthritic genu varo.