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. 2022 Jun;16(3):174-182.
doi: 10.1177/18632521221105781. Epub 2022 Jun 30.

Postoperative growth rate affects time to growth arrest after percutaneous physiodesis: A radiostereometric analysis

Maria Wingstrand  1 , Maria Elfving  2 , Gunnar Hägglund  1 , Henrik Lauge-Pedersen  1
Affiliations

Postoperative growth rate affects time to growth arrest after percutaneous physiodesis: A radiostereometric analysis

Maria Wingstrand et al. J Child Orthop. 2022 Jun.

Abstract

Purpose: The aim of this study was to determine the time at which physeal arrest is achieved after percutaneous physiodesis, and whether immediate postoperative growth rate affects the time to reach physeal arrest.

Methods: Radiostereometric analysis, with implantation of tantalum balls as radiographic markers on each side of the physes, was used to measure residual longitudinal growth in 21 children (10 boys and 11 girls) after percutaneous physiodesis for leg length discrepancy or extreme tall stature. In total, 25 femoral and 20 tibial physes were operated on. Median age at surgery was 13.9 years (range = 11.4-16.1). Radiostereometric analysis was performed postoperatively and after 3, 6, 9, 12, 26, and 52 weeks. Longitudinal growth rate <50 µm per week was defined as physeal arrest. Descriptive statistics were used for evaluation.

Results: Physeal arrest was obtained in 19 of the 21 children (40 physes) within 12 weeks postoperatively. One child was reoperated on in three out of four physes because of continued growth, and in one child, delayed physeal arrest was present at 26 weeks postoperatively. Time to physeal arrest was longer in physes with a higher immediate postoperative growth rate.

Conclusion: Postoperative follow-up with radiostereometric analysis at 12 and 15 weeks can determine whether physeal arrest has been achieved. The immediate postoperative growth rate after physiodesis seems to affect the time to physeal arrest. This implies that the risk for complications is greater for children during an accelerated growth period, for example, in boys, younger children and in distal femoral physes.

Level of evidence: level III.

Keywords: Percutaneous physiodesis; leg length discrepancy; physeal arrest; radiostereometric analysis; tall stature.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Radiostereophotogrammetric analysis postoperatively of patient no. 5. The tantalum markers in the epiphysis and metaphysis of both tibia and femur are marked with a circle. Additional markers in the image are from the reference and calibration device.
Figure 2.
Figure 2.
Growth rate after physiodesis in relation to immediate postoperative growth rate (at 3 weeks). Growth rate <50 µm/week (the dotted line) is considered physeal arrest. The interquartile range is illustrated by error bars in the figure.
Figure 3.
Figure 3.
Growth rate after physiodesis in relation to age. Growth rate <50 µm/week (the dotted line) is considered physeal arrest. The interquartile range is illustrated by error bars in the figure.
Figure 4.
Figure 4.
Growth rate after physiodesis for femur and tibia. Growth rate <50 µm/week (the dotted line) is considered physeal arrest. The interquartile range is illustrated by error bars in the figure.
Figure 5.
Figure 5.
Growth rate after physiodesis for boys and girls. Growth rate <50 µm/week (the dotted line) is considered physeal arrest. The interquartile range is illustrated by error bars in the figure.
Figure 6.
Figure 6.
Patient no 5. radiographs at (a) 6 weeks and (b) 6 months postoperatively showing visible physes. The tibia physis went to physeal arrest at 3 weeks postoperatively and the femur physis at 6 weeks postoperatively according to the RSA results (Table 1). Even at 6 months, it is not possible to rule out activity in the physis, although signs of physiodesis are present.
Figure 7.
Figure 7.
Algorithm for follow-up after physiodesis.
See this image and copyright information in PMC

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