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Incomplete Follow-up After Growth Modulation Surgery: Incidence and Associated Complications

Background: Extraperiosteal tension plates have become the predominant method for angular deformity correction in skeletally immature patients, with some surgeons using them in very young children with the intent of removing the implants once the correction is complete. The purpose of this study is to determine the incidence of incomplete follow-up and to assess the outcomes of children who were lost to follow-up with retained implants. Methods: A quality initiative survey was performed at 2 institutions on children treated with extraperiosteal tension plates around the knee because of sentinel events that occurred at each institution. Compliance with follow-up was noted, and children with open perigenicular physes on latest radiograph with retained implants were identified with attempts to reestablish care. Subsequent review of those children was performed, including clinical results, radiographic results, and the need for second deformity surgery. Results: A total of 200 children treated with tension plates were identified (116 at institution #1, 84 at institution #2). The most common indication for surgery was genu valgum (54%), and the mean age at initial surgery was 11.7 years (range, 3.1 to 16.8 y). A high rate of retained implants with incomplete follow-up was identified at both institutions, where a total of 23 patients (12%) were lost with implants still in place. Only 7 of 23 patients returned for evaluation: 3 reached skeletal maturity with no complications, but 4 overcorrected creating the opposite angular deformity. Two of those children required osteotomies to remedy their overcorrection. Two additional patients were reachable, but failed to return for follow-up and the remaining patients were unreachable. Conclusions: The incidence of incomplete follow-up was significant at both institutions (12% combined incidence). Of those who were found for follow-up, nearly one third required a surgery beyond simple implant removal. Incomplete follow-up among this cohort was identified as a significant quality of care issue, and an EMR system has been established to actively follow children receiving growth modulation surgery. Level of Evidence: Level IV.