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Predicting Late Follow-up and Understanding Its Consequences in Growth Modulation for Pediatric Lower Limb
Cheryl Lawing1, Adam Margalit, Gift Ukwuani
1Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
Journal of Pediatric Orthopedics
|June 7, 2019
Summary
Late follow-up in pediatric growth modulation is common and significantly increases the risk of overcorrection. Factors like obesity and non-English primary language are associated with delayed appointments, impacting treatment outcomes.
Area of Science:
- Pediatric Orthopedics
- Skeletal Growth Modulation
- Deformity Correction
Background:
- Growth modulation implants correct angular deformities and limb-length discrepancies (LLDs) in children.
- Close monitoring is crucial to prevent overcorrection during guided-growth procedures.
Purpose of the Study:
- To investigate factors associated with late follow-up in pediatric growth modulation.
- To determine the impact of late versus timely follow-up on overcorrection rates.
Main Methods:
- Retrospective review of 112 pediatric growth modulation cases (2000-2014).
- Deformities included ankle valgus, genu valgum, genu varum, knee flexion contractures, and LLDs.
- Late follow-up defined as ≥6-month delay; loss to follow-up as failure to return.
Main Results:
- 39% of patients experienced late or lost follow-up.
- Late follow-up was strongly associated with overcorrection (OR 19.2, P<0.005).
- Overweight/obesity and non-English primary language correlated with late follow-up.
Conclusions:
- Late follow-up is a significant risk factor for overcorrection in pediatric guided-growth surgery.
- Addressing patient factors like obesity and language barriers may improve adherence and outcomes.
- Overcorrection was particularly noted in genu valgum cases with late follow-up.
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