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Proximal Femur Guided Growth: A Systematic Review
Joshua C Tadlock1, Michael D Eckhoff1, Hunter R Graver1
1William Beaumont Army Medical Center, Department of Orthopedic Surgery & Rehabilitation, 5005 N. Piedras Street, El Paso, Texas.
Insights
Proximal femur guided growth effectively corrects coxa valga in children, improving hip alignment and preventing subluxation, particularly in those with cerebral palsy. This minimally invasive technique shows significant radiographic improvements.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Biomechanical Engineering
Background:
- Children with cerebral palsy (CP) and avascular necrosis (AVN) post-developmental hip dysplasia (DDH) treatment are prone to coxa valga.
- Coxa valga can lead to hip instability and pain, impacting mobility.
- Proximal femur guided growth (PFGG) offers a minimally invasive surgical approach.
Purpose of the Study:
- To systematically review the efficacy of proximal femur guided growth (PFGG) in correcting coxa valga.
- To evaluate radiographic outcomes, surgical variables, and complications associated with PFGG.
- To assess the impact of PFGG on children with cerebral palsy and lateral overgrowth.
Main Methods:
- Systematic review of studies reporting PFGG for coxa valga treatment.
- Analysis of radiographic parameters including migration percentage and neck-shaft angle.
- Inclusion of demographic, surgical, and complication data from 179 hips.
Main Results:
- PFGG demonstrated significant improvement in migration percentage (p < 0.0001) and neck-shaft angle (p < 0.0001).
- The procedure was performed on 117 children with CP and 62 with lateral overgrowth, with an average age of 8.1 years.
- The most frequent complication was screw growth out of the physis (30%).
Conclusions:
- PFGG is an effective technique for correcting coxa valga and improving radiographic parameters in pediatric patients.
- This method can prevent further hip subluxation in children with CP.
- PFGG modulates proximal femur growth, influencing acetabular development and correcting valgus deformities.
Abstract:
Children with cerebral palsy (CP) and those with avascular necosis (AVN) after treatment of developmental hip dysplasia (DDH) are at risk of developing coxa valga. Proximal femur guided growth is a minimally invasive option to correct this deformity. A systematic review of articles that described treatment of coxa valga with proximal femur guided growth (PFGG) and reporting on primary radiographic outcomes, demographic variables, surgical variables and complications. One hundred and seventy-nine hips underwent PFGG (117 with CP and 62 with lateral overgrowth). Average age at surgery was 8.1 years; average follow-up was 52.5 months. Migration percentage improved from 11.2% (p < 0.0001). Neck-shaft angle improved by 11.9° (p < 0.0001). The most common complication was screw growth out of the physis (30% of cases). PFGG can correct coxa valga, improve radiographic parameters, and in children with CP prevent further subluxation. This technique modulates proximal femur growth, induces changes to the acetabulum and can correct valgus deformity. Evidence Level III. (Journal of Surgical Orthopaedic Advances 32(4):049-052, 2024).
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