Are percutaneous epiphysiodesis and Phemister technique effective in the treatment of leg-length discrepancy? A systematic review

Abstract

Epiphysiodesis is considered the preferred treatment for children predicted to have leg length discrepancies (LLDs) 2–5 cm at maturity. The aim of this study was to systematically review the existing literature on the effectiveness of permanent epiphysiodesis for LLD treatment, and secondarily to address the reported complications of permanent epiphysiodesis techniques. This systematic review was performed according to PRISMA guidelines. We searched MEDLINE (PubMed), Embase, Cochrane Library, Web of Science and Scopus for studies on skeletally immature patients with LLD treated with permanent epiphysiodesis. The extracted outcome categories were effectiveness of epiphysiodesis (LLD measurements pre/post-operatively, successful/unsuccessful), physeal fusion/arrest, and complications that were graded on severity. Forty-nine studies (3051 patients) were included, 1550 underwent Phemister/modified Phemister epiphysiodesis and 1501 percutaneous epiphysiodesis (PE). Total successful permanent epiphysiodesis surgeries (16 studies) were 73.7% (516/700). Only 13 out of 23 studies had a mean final LLD of less than 1.5 cm. In total, 17.5% (513/2936) of complications were reported. 57 angular deformities were reported (1.9%). Phemister technique had higher percentage of complications (39%) than PE (19.1%) in total, but when failure to achieve adequate reduction in LLD was not included, complication rates for both were close to 14%. However, severe complications were 10.2% for Phemister group and 5.1% for PE. The high complication rates and the relative low success rate call for optimization of the timing and the applied techniques when treating LLD with permanent epiphysiodesis. Phemister technique was found to have higher percentage of severe complications than PE. Registration: PROSPERO (CRD42023435177).

Staples, tension-band plates, and percutaneous epiphysiodesis screws used for leg-length discrepancy treatment: a systematic review and proportional meta-analysis

“…Comparing the results of the current study with those in our previous published systematic review [ 53 ] on the use of percutaneous epiphysiodesis (PE) and the Phemister technique, 2 surgical techniques with permanent effect, PETS seems to have the best overall success rate, as PE had a 74% success rate and the Phemister technique a 69% success rate. However, PE was found to have less severe complications (5.1%), followed by PETS.…”

Updates in the Management of Leg Length Discrepancy: A Systematic Review

“…The current state of the relatively small surgery of permanent epiphysiodesis is interesting, nonetheless, given the availability of innovative LLD therapy alternatives such as motorized lengthening nails. A pooled analysis of the available literature revealed a 17.5% complication rate and a 73.7% success rate for permanent epiphysiodesis operations in this systematic review [24].…”