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BioMed Research International
Volume 2014, Article ID 603432, 9 pages
http://dx.doi.org/10.1155/2014/603432
Research Article

Determining the Best Treatment for Coronal Angular Deformity of the Knee Joint in Growing Children: A Decision Analysis

1Department of Orthopaedic Surgery, Myongji Hospital, 55 Hwasu-ro, 14 Beon-gil, Deokyang-gu, Goyang, Kyungki 412-826, Republic of Korea
2Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-gu, Sungnam, Kyungki 463-707, Republic of Korea
3Department of Orthopaedic Surgery, Seoul National University Children’s Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea

Received 5 June 2014; Accepted 11 August 2014; Published 3 September 2014

Academic Editor: Clément ML Werner

Copyright © 2014 Ki Hyuk Sung et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This study aimed to determine the best treatment modality for coronal angular deformity of the knee joint in growing children using decision analysis. A decision tree was created to evaluate 3 treatment modalities for coronal angular deformity in growing children: temporary hemiepiphysiodesis using staples, percutaneous screws, or a tension band plate. A decision analysis model was constructed containing the final outcome score, probability of metal failure, and incomplete correction of deformity. The final outcome was defined as health-related quality of life and was used as a utility in the decision tree. The probabilities associated with each case were obtained by literature review, and health-related quality of life was evaluated by a questionnaire completed by 25 pediatric orthopedic experts. Our decision analysis model favored temporary hemiepiphysiodesis using a tension band plate over temporary hemiepiphysiodesis using percutaneous screws or stapling, with utilities of 0.969, 0.957, and 0.962, respectively. One-way sensitivity analysis showed that hemiepiphysiodesis using a tension band plate was better than temporary hemiepiphysiodesis using percutaneous screws, when the overall complication rate of hemiepiphysiodesis using a tension band plate was lower than 15.7%. Two-way sensitivity analysis showed that hemiepiphysiodesis using a tension band plate was more beneficial than temporary hemiepiphysiodesis using percutaneous screws.