Outcomes of hemiepiphysiodesis on lower limb deformities due to rickets: A systematic review

Purpose: Rickets is a condition characterized by a defective mineralization on the epiphyseal plate, either in the form of nutritional or congenital hypophosphatemic rickets, which could lead to progressive bone deformity. One of said deformities is angular growth of the knee which can cause permanent disfigurement. Hemiepiphysiodesis is a surgical option to correct the deformity, yet the studies evaluating its results are rare. This review aimed to map the literature pertaining to this topic. Methods: A comprehensive search was performed across five databases: Pubmed, Cochrane, ProQuest, Embase, and Science Direct to identify studies involving children with rickets treated with hemiepiphysiodesis. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool, and the outcome data were compiled. Results: Six studies fulfilled the inclusion and exclusion criteria of this study with highly varied groupings and outcomes. However, the risk of bias of all studies was low to moderate. Hemiepiphysiodesis showed good outcome in function, radiological parameter, and correction rate with lower complication rate compared to osteotomy. The average time required to achieve full deformity correction was within 10.8-22.7 months. However, hemiepiphysiodesis has a risk of overshooting the correction or paradoxically rebounding to the prior condition, therefore, requiring routine follow-up. Conclusion: Hemiepiphysiodesis is beneficial for the correction of angular deformities in the knee due to rickets. Significant of studies: This review provides a crucial evidence base for clinicians by establishing hemiepiphysiodesis as a viable, less invasive alternative to osteotomy.