Determining the best treatment for coronal angular deformity of the knee joint in growing children: a decision analysis.

Ki Hyuk Sung,Moon Seok Park,Kyoung Min Lee,Seung Yeol Lee,Tae-Joon Cho,Chin Youb Chung,Won Joon Yoo,In Ho Choi

doi:10.1155/2014/603432

Abstract

This study aimed to determine the best treatment modality for coronal angular deformity of the knee joint in growing children using decision analysis. A decision tree was created to evaluate 3 treatment modalities for coronal angular deformity in growing children: temporary hemiepiphysiodesis using staples, percutaneous screws, or a tension band plate. A decision analysis model was constructed containing the final outcome score, probability of metal failure, and incomplete correction of deformity. The final outcome was defined as health-related quality of life and was used as a utility in the decision tree. The probabilities associated with each case were obtained by literature review, and health-related quality of life was evaluated by a questionnaire completed by 25 pediatric orthopedic experts. Our decision analysis model favored temporary hemiepiphysiodesis using a tension band plate over temporary hemiepiphysiodesis using percutaneous screws or stapling, with utilities of 0.969, 0.957, and 0.962, respectively. One-way sensitivity analysis showed that hemiepiphysiodesis using a tension band plate was better than temporary hemiepiphysiodesis using percutaneous screws, when the overall complication rate of hemiepiphysiodesis using a tension band plate was lower than 15.7%. Two-way sensitivity analysis showed that hemiepiphysiodesis using a tension band plate was more beneficial than temporary hemiepiphysiodesis using percutaneous screws.

Highlights

Coronal angular deformity of the lower limb is a common finding in growing children
The decision model showed that temporary hemiepiphysiodesis using a tension band plate was the best of the 3 treatment modalities
One-way sensitivity analysis showed that the expected value of temporary hemiepiphysiodesis using a tension band plate was superior to temporary hemiepiphysiodesis using percutaneous screws when the overall complication rate of temporary hemiepiphysiodesis using a tension band plate was below 15.7% (Figure 3)

Summary

Introduction

Coronal angular deformity of the lower limb is a common finding in growing children. In addition to being a cosmetic problem, it can lead to early osteoarthritis in later life because of joint overload [1]. Angular deformity can be corrected by guided growth of the physis in growing children. Permanent hemiepiphysiodesis by physeal ablation was first introduced by Phemister in 1933 [2]. Accurate timing of the surgery is crucial because improper timing can lead to over- or undercorrection [3]. Temporary hemiepiphysiodesis using staples [4], percutaneous screws [5], or a tension band plate [6] is commonly used in these patients

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Methods

Results

Conclusion