Recurrence of deformity in Blount’s disease after surgical correction
No Thumbnail Available
Date
2019
Authors
van Greunen, Eduard
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Introduction: Blount’s disease may recur after surgical correction of the deformity. Vastly different recurrence rates have been reported in the literature. The aim of this study was to investigate the recurrence rate of infantile and juvenile Blount’s disease following high tibial and fibular valgus osteotomy at the Chris Hani Baragwanath Academic hospital.
Method: This was a retrospective cohort comparative study. We analysed the files, theatre records and X-rays of 44 patients who presented with infantile or juvenile Blount’s disease at Chris Hani Baragwanath Academic Hospital from 1 January 2009 until 31 August 2018. Demographics, family history, body mass index, walking age and age at surgery were determined. Pre-, post- and follow up anatomic femorotibial angles, were measured from Xrays. The limbs were divided into Langenskiöld stages based on pre-operative X-rays.
Results: The study found an overall recurrence rate of 63.3% in limbs with Blount’s disease. In the infantile group 59.2% of limbs had recurrence while in the juvenile group there was a limb recurrence rate of 72.2%. Surgery after the age of four years was identified as a risk factor for recurrence in infantile Blount’s disease. Other factors identified as significant for recurrence were advanced Langenskiöld stages and overcorrection of less than 15 degrees of valgus.
Obesity, early walking, gender and the pre-operative anatomical femorotibial angle were not found to be risk factors for recurrence in this study.
Conclusion: The recurrence rate for high tibial valgus osteotomies at Chris Hani Baragwanath Academic Hospital for infantile Blount’s disease was 59.2% and 72.2% in the study period for infantile and juvenile types, respectively. Surgery after the age of four years, late presentation, advanced Langenskiöld stages and overcorrection of less than 15 degrees of valgus were noted to increase the recurrence rate. Using results from the literature and the findings in this study it is recommended to perform a high tibial valgus osteotomy with overcorrection before the age of four years in infantile Blount’s disease. Early referral of tibial bowing should be encouraged to prevent higher Langenskiöld stages at time of presentation and allow for earlier surgery to reduce the recurrence of deformity.
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine,
Johannesburg, 2019