Follow-Up After Hemiepiphysiodesis: Can We Do Better?

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Skeletal deformities

Background:

• Hemiepiphysiodesis for pediatric limb deformities carries a risk of overcorrection, especially with suboptimal patient follow-up.
• Limited research exists on predictive factors for follow-up adherence after hemiepiphysiodesis.
• This study investigates sociodemographic predictors of late or lost follow-up after knee and ankle hemiepiphysiodesis.

Purpose of the Study:

• To identify sociodemographic factors associated with late follow-up (LFU) and lost to follow-up (LTFU) in pediatric patients undergoing hemiepiphysiodesis.
• To determine the impact of poor follow-up on overcorrection rates and the need for subsequent procedures.
• To inform quality improvement initiatives for high-risk patient groups.

Main Methods:

• Retrospective review of skeletally immature patients who underwent hemiepiphysiodesis for coronal knee/ankle deformities (2018-2022).
• Follow-up status categorized as on-time (OTFU), late (LFU), or lost (LTFU).
• Radiographic measurements (mechanical axis, LDTBA) assessed preoperatively and postoperatively; overcorrection stratified by severity. Multivariate analysis used.

Main Results:

• 155 patients included: 103 OTFU, 28 LFU, 24 LTFU.
• Significant predictors of LTFU included higher Area Deprivation Index (ADI), male sex, Black race, and uninsured status.
• Overcorrection was noted in LFU patients, particularly those with genu varum (38.5% severe overcorrection). Genu varum and Blount disease were predominant in LFU/LTFU groups.

Conclusions:

• Inadequate follow-up post-hemiepiphysiodesis can lead to significant overcorrection, potentially requiring revision surgery.
• Sociodemographic factors like high ADI, male sex, Black race, and lack of insurance are associated with LTFU.
• Targeted quality improvement strategies are essential to ensure consistent follow-up in vulnerable pediatric populations.