Determinants of Surgical Response to Lateral Tibial Hemiepiphysiodesis in Idiopathic and Non-Idiopathic Genu Varum: Real-World Evidence from a Tertiary Pediatric Cohort

Background: Lateral tibial hemiepiphysiodesis with tension band plates is an established method for correcting genu varum in skeletally immature patients. However, outcomes may vary depending on underlying pathology and patient characteristics. Methods: This retrospective cohort study evaluated 31 patients (53 knees) treated between 2011 and 2024 at a tertiary pediatric orthopedic center. Patients were categorized as idiopathic or non-idioathic genu varum based on diagnosis. Inclusion criteria required open physes, absence of previous or concomitant knee surgeries for alignment correction, and availability of standardized long-standing radiographs. Radiographic parameters, including mechanical axis deviation (MAD), hip–knee–ankle angle (HKA), and medial proximal tibial angle (MPTA), were assessed pre-operatively and at implant removal. Outcomes were classified as complete correction, partial correction, absent correction, overcorrection, or progression of deformity. Results: Overall, 64.2% of knees achieved complete correction. Success was significantly higher in idiopathic cases (82.1%) than in non-idiopathic deformities (44%). Success was also more frequent in males (p = 0.040). In multivariable analysis, non-idiopathic patients (β = 351.9; p = 0.002), HKA improvement (β = 1.4; p = 0.010) and change in BMI z-score (β = 202.4; p = 0.009) independently predicted surgical success. No major complications (Clavien–Dindo–Sink grade > 2) were observed. Conclusions: Lateral tibial hemiepiphysiodesis is effective for idiopathic genu varum, offering minimally invasive correction with low complication rates. However, outcomes in non-idiopathic deformities are less predictable, emphasizing the need for individualized treatment planning and counseling. Early intervention, careful implant positioning, and rigorous follow-up are essential to optimize results and prevent unintended overcorrection.