Westberry David E, Davids Jon R, Pugh Linda I, Blackhurst Dawn
Shriner's Hospital for Children, Greenville Unit, Greenville, South Carolina, USA.
J Pediatr Orthop B. 2004 Nov;13(6):374-8. doi: 10.1097/01202412-200411000-00005.
Tibia vara is a condition characterized by progressive deformity of the proximal tibia resulting in varus malalignment of the lower extremity. An alternative treatment strategy involving lateral hemiepiphyseodesis of the proximal tibia in the skeletally immature has been utilized at our institution for the last 10 years. The study group consisted of 23 patients (16 male, seven female) with 33 involved extremities. The median age at surgery was 11.8 years (range, 7.0-17.3). The median follow-up was 3.1 years (range, 0.8-6.2). Of the patients, 82.6% had a weight greater than the 95th percentile. The preoperative mechanical axis had a median value of 18.0 degrees (range, 5.0-31.0) and at the most recent follow up, a median value of 7.0 degrees (range, -12.0 to 46.0). In 18 (54.5%) extremities, the mechanical axis improved by more than 5 degrees . There was no progression of the overall deformity in 11 (33.3%) extremities. Four (12.1%) extremities had worsening of the deformity. At the time of latest follow up, nine (27.2%) extremities had required corrective osteotomy. Twenty-four (72.7%) were skeletally mature and had not required any further treatment. Goals of hemiepiphyseodesis in adolescent tibia vara or late sequelae of infantile tibia vara include (1) correction of deformity to avoid need for osteotomy, and (2) prevention of progression of the deformity to facilitate subsequent surgery. In this series of patients, 87.8% had either improvement or stabilization of the degree of their deformity.
