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Epiphysiodesis: a problem of timing

V P Blair, S J Walker, J J Sheridan

    Journal of Pediatric Orthopedics
    |August 1, 1982
    PubMed
    Summary
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    Surgical correction of leg length inequality using epiphysiodesis had a high failure rate. Errors in surgical timing and technique, rather than growth prediction, were the main causes of poor outcomes.

    Area of Science:

    • Orthopedic Surgery
    • Pediatric Orthopedics
    • Growth Management

    Background:

    • Leg length inequality is a common pediatric orthopedic condition.
    • Epiphysiodesis is a surgical procedure to correct leg length discrepancies.
    • Previous methods for predicting growth and timing surgery have shown variable success.

    Purpose of the Study:

    • To evaluate the effectiveness of distal femoral and proximal tibial epiphysiodesis for correcting leg length inequality.
    • To identify the primary causes of failure in this surgical procedure.
    • To assess the utility of growth prediction methods in optimizing surgical timing.

    Main Methods:

    • Retrospective review of 67 epiphysiodesis procedures over 14 years.
    • Analysis of final leg length discrepancy in all patients.

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  • Categorization of failures into surgical inadequacy and timing errors.
  • Comparison of growth prediction methods used (Green and Anderson tables vs. Moseley Graph).

    • Main Results:

    • Only 22 out of 67 patients achieved a final discrepancy of less than 1 cm.
    • 45% of cases (45/67) were considered failures.
    • Inadequate surgical technique accounted for 10 failures.
    • Incorrect surgical timing based on flawed growth prediction tables caused 35 failures.
    • The Moseley Graph and careful follow-up were suggested to improve outcomes.

    Conclusions:

    • Distal femoral and proximal tibial epiphysiodesis, when performed with current methods, has a high failure rate for correcting leg length inequality.
    • Surgical timing errors, stemming from inaccurate growth prediction, are a more significant cause of failure than surgical technique.
    • Improved surgical timing through more accurate growth prediction tools like the Moseley Graph and diligent patient follow-up are crucial for successful epiphysiodesis outcomes.