Indications and timing in isolated medial femoral hemiepiphysiodesis for idiopathic genu valgum: A systematic review

• Published in: The knee Vol. 40; pp. 52 - 62
• Main Authors: Artioli, Elena, Mazzotti, Antonio, Ramacci, Vanina, Zielli, Simone Ottavio, Digennaro, Vitantonio, Ruffilli, Alberto, Faldini, Cesare
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2023
• Subjects: Asymmetrical epiphysiodesis; Child; Femur - diagnostic imaging; Femur - surgery; Genu valgum; Genu Valgum - diagnostic imaging; Genu Valgum - surgery; Guided growth; Hemiepiphysiodesis; Humans; Knee; Radiography; Retrospective Studies; Knee; Guided growth; Hemiepiphysiodesis; Genu valgum; Asymmetrical epiphysiodesis
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2022.11.009

•Temporary hemiepiphysiodesis is an effective procedure to treat genu valgum.•Incorrect timing or indications could compromise the outcomes.•Patients undergoing surgery should be minimum 8 years old.•An IMD > 8 cm and a mLDFA < 87° are shared threshold values to consider surgery.•Postoperative evaluation should be scheduled every 3–6 months. Temporary isolated medial femoral hemiepiphysiodesis (TIMFH) represents a safe and effective technique widely used to treat idiopathic genu valgum. Recent studies mainly concentrated on comparing outcomes of different implants, while less attention has been reserved to the proper indications and timing for surgery. The aim of this systematic review was to provide evidence-based guidelines about indications for device implant and removal and postoperative management. A comprehensive literature search was performed across three databases to select articles concerning TIMFH in the treatment of idiopathic genu valgum. Studies involving other etiologies or concomitant surgical procedures were excluded. Quality assessment of the included studies was conducted through the Newcastle-Ottawa Scale. Ten studies involving 237 patients for a total of 446 knees were included in the analysis. Mean age at surgery was 11,4 years. Patients were considered for surgery using various clinical and radiological parameters. Intermalleolar distance (IMD) and mechanical lateral distal femoral angle (mLDFA) were the most common evaluated. Mean treatment time was 12 months. Rebound of the deformity occurred in 6,7% of cases. Results of this review showed good consensus among authors. Patients undergoing TIMFH for IGV should be minimum 8 years old, with an IMD greater than 8 cm and a mLDFA lower than 87°. Postoperative management should comprise of quarterly clinic evaluations, and follow-up should last until skeletal maturity. The application of more uniform parameters in clinical practice may improve the establishment of the optimal timing for implant removal.