What is the treatment for Blount's disease?

Treatment of Blount's Disease

The treatment of Blount's disease requires surgical intervention, with the specific approach determined by the patient's age, skeletal maturity, and severity of deformity. 1, 2

Understanding Blount's Disease

Blount's disease (tibia vara) is a growth disorder characterized by abnormal growth of the medial proximal tibial physis resulting in progressive tibial bowing. It is strongly associated with obesity, with higher BMI correlating with increased risk of developing the condition 3, 1.

Treatment Options Based on Patient Factors

Age-Based Treatment Algorithm:

1. Young Children (< 4 years old):

   • First-line treatment: Simple osteotomy to correct the deformity 4
   • Progressive Blount's disease should be corrected promptly at this age

2. Children with Growth Remaining (4-10 years):

   • Guided growth technique using lateral tension band plates/hemiepiphysiodesis is recommended as first-line treatment 5
   • Advantages: Minimally invasive, predictable results, well-tolerated
   • Average time to correction: 13.5 months (range 8-19 months)
   • Success rate: ~78% of limbs achieve complete normalization of mechanical axis 5

3. Older Children/Adolescents with Severe Deformity:

   • Osteotomy with external fixation (particularly hexapod frames like Taylor Spatial Frame) 6, 2
   • Indicated for patients with:
     • Severe deformities
     • Limited remaining growth
     • Presence of medial tibial epiphysiodesis (typically develops at 6-8 years)

4. Special Cases (> 7 years with advanced disease):

   • May require medial hemiplateau elevation combined with lateral proximal tibial hemiepiphysiodesis 7

Severity-Based Treatment Considerations

• Mild to Moderate Deformity: Guided growth techniques are appropriate
• Severe Deformity: Requires osteotomy with gradual correction using external fixation
• Cases with Physeal Bar: Physeal bar resection may be necessary before other interventions 5

Important Clinical Considerations

• Monitoring: All patients require regular follow-up until skeletal maturity due to risk of recurrence 7
• Rebound Varus: Can occur but is easily remedied by repeating guided growth procedure 5
• Weight Management: Critical component of treatment as obesity is a significant risk factor 1
• Contraindications for Guided Growth:
  • Unresectable physeal bar
  • Skeletal maturity 5

Treatment Goals

1. Restore normal joint and limb alignment
2. Equalize limb lengths at skeletal maturity
3. Prevent recurrence of deformity
4. Prevent complications including premature medial compartment knee arthritis 2

Complications to Monitor

• Hardware failure (screw breakage, migration)
• Recurrent deformity
• Limb length discrepancy
• Premature osteoarthritis in untreated or inadequately treated cases 4

The surgical approach to Blount's disease has evolved significantly, with guided growth techniques gaining popularity for patients with growth remaining, while osteotomies with external fixation remain the standard for severe deformities and cases with limited growth potential.