Novel PhD on Surgical Management of Blount’s Disease in Children

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Blount’s disease is a complex, progressive condition found in children that affects the growth plates around the knee - considered a “proximal tibial deformity” by orthopaedic surgeons.

Despite it being a relatively rare condition according to international literature, it is frequently encountered in orthopaedic practice in South Africa.

South African orthopaedic surgeons are, therefore, frequently faced with the challenging surgical decision-making process in Blount’s disease. This challenge stems from the broad spectrum of disease severity and morphology (physical structure) at presentation and the lack of evidence-based guidelines that guide treatment strategy selection.

Supervised by UKZN’s Head of Orthopaedic Surgery and Interim Dean of the School of Clinical Medicine, Professor Len Marais, Dr Piet Mare graduated with a PhD in Orthopaedic Surgery on 6 May for his doctoral research that aimed to structure the surgical treatment selection process for Blount’s disease.

The study entailed a narrative review of the literature to identify areas where evidence was lacking, or where controversy existed to focus further research. Once the diagnosis of Blount’s disease was made, the recommended treatment was surgical deformity correction.

Mare said, ‘The most frequent complication after acute correction through a metaphyseal proximal tibial osteotomy was found to be recurrent deformity. It appeared that worse clinical outcomes are associated with recurrent deformity, with insufficient evidence to guide recurrence risk assessment effectively. Additionally, few surgical procedures to decrease recurrence risk had been described, and evidence to support their use was lacking. The most serious complications following tibial osteotomy and deformity correction were vascular injury, compartment syndrome and deep infection.’

In its many findings, the study confirmed that both advanced skeletal maturity and increased deforming forces had been demonstrated in obese children with Blount’s disease. The study’s surgical treatment selection strategy was summarised in a comprehensive assessment and treatment algorithm that requires further evaluation in terms of recurrence rate, complications, and outcome at skeletal maturity.

‘Future research should focus on strategies to predict and decrease recurrence risk and to determine the optimal indications for guided growth in Blount’s disease,’ said Mare who was thrilled to be conferred with a PhD.

He was congratulated by Marais on his outstanding achievement.

Words: Lunga Memela

Photograph: Sethu Dlamini