Abstract
Purpose of Study
To assess the radiological outcomes of medial screw epiphyseodesis of the proximal femoral physis in the management of lateral growth arrest following treatment of developmental dysplasia of the hip.
Methods
We identified 10 patients noted to have lateral growth disturbance of the proximal femoral physis, 9 of which were managed with medial screw epiphyseodesis. Serial radiographs were reviewed. A new technique was employed to monitor progression of lateral growth arrest and also to assess the role of screw epiphyseodesis in preventing further deterioration or indeed allowing for improvement. This method involved calculating the tilt angle (angle formed between a horizontal reference line and a line joining medial and lateral points of physis) and following its progression with increasing age.
Results
10 patients were included in the study, 7 females and 3 males. 1 patient did not have screw epiphyseodesis performed and is used as a control. The left hip was affected in 8 and the right hip in 2 patients. Average age at surgery (medial screw epiphyseodesis) was 12 years. 5 of the 9 patients that had screw epiphyseodesis demonstrated improvement in tilt angles (i.e. correction of deformity) with sequential follow up. 2 patients failed to improve. 2 demonstrated no change. In the control case, rapid deterioration was seen in the tilt angle following 9 years of age although this reached a plateau at age 11.
Conclusion
Although the numbers in this series are modest, our results do give support for the role of medial screw epiphyseodesis in the presence of lateral growth arrest for guided growth of the proximal femoral physis. Our results suggest that screw epiphyseodesis should be performed at approximately 9 years of age to optimise potential for guided growth and to prevent further deterioration.
