Guided Growth Improves Coxa Valga and Hip Subluxation in Children With Hereditary Multiple Exostoses
Journal
Journal of pediatric orthopedics
Journal Volume
43
Journal Issue
1
Pages
E67
Date Issued
2023-01-01
Author(s)
Abstract
Background: In children with severe hereditary multiple exostoses (HME), coxa valga, and hip subluxation are common deformities. The literatures related to surgical management and prevention of hip joint subluxation in HME are scarce. In this study, we aimed to investigate the efficacy of guided growth procedure to correct coxa valga and hip subluxation in HME patients.
Methods: We retrospectively retrieved 12 patients who received guided growth procedures for coxa valga and hip subluxation in HME patients with proximal femur exostoses with a minimum follow-up time of 2 years between 2012 and 2019. Radiographic parameters include head-shaft angle, Hilgenreiner-epiphyseal angle, acetabular index, Reimer migration percentage, center-edged angle, articulo-trochanteric distance, and femoral neck length for comparison between preoperative and latest follow-up results. It was conducted statistically by paired t test and Wilcoxon signed rank test.
Results: In this study, the mean difference between preoperative and latest follow-up was significant in head-shaft angle (12±5 degrees; CI, 10-14; P<0.001), Hilgenreiner-epiphyseal angle (12±5 degrees; CI, 10-15; P<0.001), and MP (7%±8%; CI, 3-11; P=0.001). There was a low revision rate (4 of 21, 19%) and no complication in our study. Compared with previous studies on guided growth in children with cerebral palsy and developmental dysplasia of the hip, our study showed good comparable outcomes.
Conclusion: The results indicated that guided growth improves the hip radiographic parameters of children with HME and may prevent coxa valga and hip subluxations. It is a safe procedure and provides predictable results.
Level of evidence: Level IV; therapeutic, case series.
Subjects
hereditary multiple exostoses
coxa valga
hip subluxation
guided growth
pediatric orthopaedics
HEAD-SHAFT ANGLE
DEVELOPMENTAL DYSPLASIA
PROXIMAL FEMUR
FEMORAL-HEAD
DISPLACEMENT
MANAGEMENT
RISK
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Type
journal article