Efficacy and Safety of Transphyseal Screw Hemiepiphysiodesis for Lower Limb Deformity Correction in Pathological Bone Conditions: A Systematic Review.

Transphyseal screw hemiepiphysiodesis is a minimally invasive technique for guided growth correction of angular deformities and limb-length discrepancies of the lower extremities in the pediatric population. Pathological bone conditions, including Blount disease, hereditary multiple exostoses (HME), cerebral palsy (CP), and other neuromuscular disorders, present unique challenges that may affect correction rates, rebound risk, and postoperative complications. The purpose of this study is to review the outcomes and complications of transphyseal screw hemiepiphysiodesis in skeletally immature patients with defined pathological bone conditions. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO ID: CRD420261426720), a systematic search of PubMed, Embase, and the Cochrane Library was conducted from inception to May 2026. Inclusion required a defined pathological etiology, transphyseal screw intervention, at least five patients or limbs, a quantitative radiographic outcome, and a minimum of six months of follow-up, with study quality assessed using the methodological index for non-randomized studies (MINORS) criteria. Twenty studies encompassing 657 patients and 1,072 limbs/segments were ultimately included and grouped into four anatomic categories: ankle/distal tibia (9 studies, 358 patients), knee coronal plane (4 studies, 121 patients), knee sagittal plane (4 studies, 113 patients), and hip (3 studies, 65 patients). Ankle valgus correction rates ranged from 0.24° to 0.90°/month across pathological diagnoses, with significantly faster rates in CP than in spina bifida or HME. For coronal knee deformity in Blount disease, the mean mechanical axis deviation correction rate was 3.66 ± 1.51 mm/month, and 90% surgical success was achieved in adolescent tibia vara. Additionally, coxa valga in CP improved, with mean head-shaft angle reductions of 13°-14° over two years. Complications were predominantly hardware-related, including difficult screw extraction, the physis growing off the screw, and rebound valgus in several ankle cases depending on etiology. In conclusion, transphyseal screw hemiepiphysiodesis is effective across a broad spectrum of pathological bone conditions, producing statistically and clinically significant deformity correction at the ankle, knee, and hip. However, correction rates vary meaningfully by etiology, hardware issues remain the primary complication, and rebound deformity remains a distinct concern after premature screw removal, particularly in patients with HME and CP.