Artikel
Anterior distal femoral hemiepiphysiodesis can reduce fixed flexion deformity of the knee: A retrospective study
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Autoren
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Norbert Stiel
- Altonaer Kinderkrankenhaus gGmbH, Kinderorthopädie, Hamburg, Germany
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Kornelia Babin
- Altonaer Kinderkrankenhaus gGmbH, Kinderorthopädie, Hamburg, Germany
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Sandra Breyer
- Altonaer Kinderkrankenhaus gGmbH, Kinderorthopädie, Hamburg, Germany
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Nicola Ebert
- Altonaer Kinderkrankenhaus gGmbH, Kinderorthopädie, Hamburg, Germany
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Johannes M. Rueger
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Hamburg, Germany
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Martin Rupprecht
- Altonaer Kinderkrankenhaus gGmbH, Kinderorthopädie, Hamburg, Germany
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Ralf Stücker
- Altonaer Kinderkrankenhaus gGmbH, Kinderorthopädie, Hamburg, Germany
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Alexander S. Spiro
- Altonaer Kinderkrankenhaus gGmbH, Kinderorthopädie, Hamburg, Germany
| Veröffentlicht: | 6. November 2018 |
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Gliederung
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Objectives: Fixed knee flexion deformity is a common problem in diverse diseases including myelomeningocele and cerebral palsy in children. Until now just a limited number of studies, focusing on the surgical procedure of anterior distal femoral hemiepiphysiodesis, have been published. This retrospective study analyses the outcome and effects of anterior distal femoral hemiepiphysiodesis in fixed flexion deformity of the knee.
Methods: In the largest case series to date, we reviewed the medical records of all patients with fixed knee flexion deformity treated with this method using either staples or eight plates between 2002 and 2017. 74 patients and all together 132 knees (58 bilateral, 16 unilateral fixations) were included. Patients were assigned to 3 different groups according to their diagnosis (cerebral palsy; myelomeningocele; "other" group).
Results and conclusion: The average age at operation was 11.8 years (6.1-20.0). Mean fixed knee flexion deformity improved from 20,3° (10-60°) to 8,1° (0-50°) (p<0.001) with an average correction rate of 0,44° per month (-2,14° - 1,74°). The material was removed after a mean of 32 months (6-72). The correction rate per month was lowest for patients with cerebral palsy (0,23°), followed by the myelomeningocele group (0,47°), and the "other" group (0,58°). There was a significant difference in the correction rate between group 1 and 3 (p = 0,02). Staple loosening occurred in 13 of 102 treated knees with consecutive re-stapling in 7 knees. In summary this minimal invasive technique with immediate mobilization, short operation time and less associated risks offers a huge amount of advantages. It seems to be an effective treatment for fixed knee flexion deformity in patients with a wide spectrum of underlying diagnoses.
