Temporary epiphyseodesis for limb-length discrepancy. 8- to 15-year follow-up of 34 children

BACKGROUND AND PURPOSE: For the treatment of leg-length discrepancies (LLDs) of between 2 and 5 cm in adolescent patients, several epiphyseodesis options exist and various complications have been reported. We reviewed the 8- to 15-year outcome after temporary epiphyseodesis in patients with LLD.

PATIENTS AND METHODS: 34 children with LLD of up to 5 cm were included in the study. Mean age at epiphyseodesis was 12.8 (10-16) years. Temporary epiphyseodesis was performed with Blount staples or 8-plates. The LLD was reviewed preoperatively, at the time of implant removal, and at follow-up. Every child had reached skeletal maturity at follow-up. Long-standing anteroposterior radiographs were analyzed with respect to the mechanical axis and remaining LLD at the time of follow-up. Possible complications were noted.

RESULTS: The mean LLD changed from 2.3 (0.9-4.5) cm to 0.8 (-1.0 to 2.6) cm at follow-up (p<0.001). 21 patients had a final LLD of <1 cm, and 10 had LLD of <0.5 cm. At the time of follow-up, in 32 patients the mechanical axis crossed within Steven's zone 1. No deep infections or neurovascular lesions were seen. 4 implant failures occurred, which were managed by revision.

INTERPRETATION: Temporary epiphyseodesis is an effective and safe option for the treatment of LLD. The timing of the procedure has to be chosen according to the remaining growth, facilitating a full correction of the LLD. If inaccurate placement of staples is avoided, substantial differences between the mechanical axes of both legs at skeletal maturity are rare.