Risk factors for reoperations following guided growth around the knee

Area of Science:

• Pediatric Orthopedics
• Surgical Outcomes
• Growth Modulation

Background:

• Guided growth with tension band plates is a standard treatment for pediatric genu varum and valgum.
• Reoperation is a significant concern following these procedures.
• Identifying risk factors for reoperation is crucial for improving patient outcomes.

Purpose of the Study:

• To determine the causes and risk factors associated with reoperations after guided growth around the knee in children.
• To analyze the incidence and reasons for revision surgeries in this patient population.

Main Methods:

• Retrospective review of 91 children (142 knees) treated with guided growth between 2012 and 2019.
• Comparison of potential risk factors (age, sex, BMI, etiology, deformity type) between reoperated and non-reoperated knees.
• Logistic regression analysis to identify significant risk factors for reoperation.

Main Results:

• A 39.5% reoperation rate was observed, with common causes including deformity recurrence (26 knees) and slow response (13 knees).
• Younger age (OR 0.6 per year older) and non-idiopathic etiologies (OR 3.5) were significant risk factors for reoperation.
• An age cutoff of 10.1 years demonstrated high sensitivity (73%) and specificity (91%) in predicting reoperation.

Conclusions:

• Reoperation rates can exceed 50% in specific non-idiopathic conditions like rickets or Blount's disease.
• Timely intervention is vital for progressive deformities, and retaining hardware may be beneficial for potential recurrence.
• Delaying guided growth until after age 10 in asymptomatic idiopathic cases may reduce reoperation risk.