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New Single-stage Double Osteotomy for Late-presenting Infantile Tibia Vara

A Comprehensive Approach

Abraham, Edward, MD*,†; Toby, David, MD; Welborn, Michelle C., MD; Helder, Cory W., BS*; Murphy, Angela, MCSP

Journal of Pediatric Orthopaedics: May/June 2019 - Volume 39 - Issue 5 - p 247–256
doi: 10.1097/BPO.0000000000000926
Knee/Tibia
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Background: Successful surgical treatment of late-presenting infantile tibia vara (ITV) patient requires the correction of oblique deformities. The purpose of this study was to report on a new comprehensive approach to correct and prevent recurrence of these deformities with a single procedure.

Methods: Medical records of 23 consecutive children (7 to 18 y) with advanced ITV (29 knees) were retrospectively reviewed after a mean of 7.3 years postoperatively (range, 2 to 22 y). Indications for the corrective surgery were any child 7 year or older with a varus mechanical axis angle ≥10 degrees or a varus anatomic axis angle ≥11 degrees and a medial tibial angle (MTA) slope <60 degrees. The deformities were corrected with a dome-shaped osteotomy proximal to the tibial tubercle with a midline vertical extension to the subchondral region of the joint and a lateral hemi-epiphysiodesis.

Results: At latest follow-up, means and medians of each tibial radiographic axis measurement improved significantly from preoperative values (P<0.001): mechanical axis angle from 23 degrees to 4 degrees varus, anatomic axis angle from 25 degrees varus to 1 degree valgus, MTA downward slope from 30 to 78 degrees, posterior MTA from 59 to 80 degrees. In total, 79% and 74% had good to excellent results based on radiographic criteria and clinical questionnaire for satisfaction, pain and function, respectively. Two abnormal medial tibial plateau types were described.

Conclusions: This is the first study to use a single-stage double osteotomy performed proximal to the tibial tubercle for the late-presenting ITV for children 7 years of age or older. In addition to the effective correction of the 4 major tibial deformities, a lateral proximal tibial hemi-epiphysiodesis minimizes recurrence of tibia vara. A contralateral proximal tibial epiphysiodesis is recommended for treated skeletally immature patients with unilateral disease.

Level of Evidence: Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.

*Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL

The Princess Elizabeth Medical Centre, Port of Spain, Trinidad and Tobago

Shriners Hospital for Children, Portland, OR

Supported by National Center for Advancing Translational Sciences, at the University of Illinois School of Medicine at Chicago, National Institutes of Health, through Grant UL1TR000050 was used in part to fund this research study. No authors received any funding personally.

The authors declare no conflicts of interest.

Reprints: Edward Abraham, MD, 835 S Wolcott Avenue, RM E270, Chicago, IL 60612. E-mail: eda@uic.edu.

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