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Do Different Tibial Osteotomy Techniques Affect Sagittal Alignment in Children with Blount Disease?
Piyanuch Musikachart1,2, Perajit Eamsobhana1,2
1Department of Biochemistry,, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Dome and wedge-shaped proximal tibial osteotomies showed no significant difference in posterior tibial slope (PTS) angle for infantile Blount disease. Both surgical techniques effectively managed sagittal alignment in young patients.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Radiographic analysis
Background:
- Infantile Blount disease is a progressive condition affecting the proximal tibia, leading to varus deformity.
- Surgical correction, often involving proximal tibial osteotomy, is necessary to restore proper knee alignment.
- Evaluating different osteotomy techniques is crucial for optimizing outcomes.
Purpose of the Study:
- To compare radiographic outcomes of dome-shaped versus wedge-shaped proximal tibial osteotomy in infantile Blount disease.
- To assess the effect of these osteotomies on sagittal knee alignment, specifically the posterior tibial slope (PTS) angle.
Main Methods:
- Retrospective review of 72 surgeries in 46 patients (aged ≤5 years) with Langenskiöld stage 2 Blount disease.
- Analysis of anteroposterior and lateral knee radiographs to measure femorotibial angle (FTA) and posterior tibial slope (PTS) angle.
- Comparison of outcomes between dome-shaped and wedge-shaped proximal tibial osteotomy groups.
Main Results:
- No significant demographic or baseline differences between the dome and wedge osteotomy groups.
- Both techniques achieved correction of varus deformities, with average FTA corrections of 29.59° (dome) and 27.25° (wedge).
- Postoperative PTS angles showed no significant differences between the two surgical techniques at various follow-up intervals.
Conclusions:
- Dome and wedge-shaped proximal tibial osteotomies yield comparable radiographic outcomes in managing infantile Blount disease.
- Neither technique demonstrated a significant advantage in improving sagittal knee alignment (PTS angle).
- Both surgical approaches are viable options for correcting varus deformities in this patient population.
Objective:
To determine the radiographic outcomes following dome or wedge-shaped proximal tibial osteotomy in the management of infantile Blount disease with a particular interest in sagittal alignment of the knee joint.
Method:
Medical records of patients with Langenskiöld stage 2 Blount disease (aged ≤5 years) who underwent surgical correction between January 2005 and November 2019 were retrospectively identified. Patients with metabolic bone disease, bone tumors, prior traumatic fractures, congenital anomalies, inadequate plain films, and incomplete medical documents were excluded. Patient characteristics (e.g. age, gender, and body mass index [BMI]) and surgical characteristics (e.g. side, type of surgery, and follow-up times) were recorded. Antero-posterior (AP) and lateral knee radiographs were analyzed. Data were categorized by surgical technique as dome-shaped proximal tibial osteotomy or wedge-shaped proximal tibial osteotomy. The femorotibial angle (FTA) was used to evaluate the correction angle in varus deformities. Sagittal alignment of the lower limbs using the posterior tibial slope (PTS) angle was measured postoperatively at 3, 6, 12, and 24 months, and at the final follow-up visit.
Results:
The present study included 72 surgeries of 46 patients who had undergone proximal tibial osteotomy. Twenty-nine (63%) were male. The mean age of patients at the time of surgery was 34.50 months (range, 26-47). The mean weight was 23.11 ± 4.98 kg (mean ± SD); the mean height was 95.33 ± 6.36 cm, and the mean BMI was 25.32 ± 4.36 kg/m2 . The mean duration of follow up was 4.77 ± 2.78 years. Sixty-four patients (88.90%) received dome-shaped proximal osteotomy of the tibia, while 8 (11.10%) received wedge-shaped proximal osteotomy of the tibia. The average FTA of the total correction measured was 29.32° ± 7.98°. The demographic data of the two groups were not significantly different for gender, age, BMI, side follow-up times, and the total correction of varus deformities. In the dome-shaped osteotomy group, the mean correction of the FTA was 29.59° ± 7.45°. The mean degree of the PTS angle was 6.50° at 3 months, 6.38° at 6 months, 5.32° at 12 months, 5.17° at 24 months, and 5.53° at the final follow-up visit. In the wedge-shaped proximal tibial osteotomy group, the mean correction of the FTA was 27.25° ± 11.77°. The PTS was 6.00° at 3 months, 7.50° at 6 months, 7.00° at 12 months, 5.40° at 24 months, and 5.57° at the final follow-up visit. No significant difference was observed in the radiological outcome between surgical techniques.
Conclusion:
Dome and wedge-shaped proximal tibial osteotomies did not demonstrate significant differences in the PTS angle in children with Blount disease.
