Postoperative Follow-Up After Hemiepiphysiodesis in a Low-Opportunity Urban Population: A Retrospective Study

ABSTRACT Background Temporary hemiepiphysiodesis (THE) is an effective, minimally invasive method to correct lower-extremity angular deformity in skeletally immature patients; however, its success depends on time-sensitive postoperative follow-up to monitor correction and determine timely implant removal. This study evaluated (1) whether patient- and neighborhood-level socioeconomic factors are associated with delayed or incomplete follow-up after THE and (2) whether delayed follow-up is associated with adverse clinical outcomes in a predominantly low-opportunity, urban pediatric population. Methods IRB-approved retrospective study of patients <18 years undergoing knee or ankle hemiepiphysiodesis from 2015–2024 at a single urban tertiary children’s hospital. Follow-up adherence was classified relative to surgeon-recommended intervals as on-time, delayed (slightly, moderately, very), or lost to follow-up. Socioeconomic variables include insurance type, interpreter use, MyChart status, Area Deprivation Index (ADI), and Child Opportunity Index (COI). Outcomes were overcorrection and unplanned surgery for overcorrection; cases with insufficient follow-up were categorized as indeterminate outcome. Results Among 154 patients, 55% returned within 3 months of the recommended follow-up interval, 32% returned later than recommended, and 13% were lost to follow-up. Insurance type, MyChart status, ADI, and COI domains were not associated with follow-up adherence (all p≥0.73). Interpreter use was more common in delayed groups than the on-time group (29%–36% vs 11%; p=0.03). Overcorrection occurred only among patients with delayed follow-up (14%-29% vs 0% among patients returning within 3 months; p<0.001). Unplanned surgery for overcorrection occurred exclusively among patients who returned more than 12 months later than recommended (43%; p<0.001). Conclusions In this urban pediatric cohort, just over half of patients returned within 3 months of the recommended follow-up interval after hemiepiphysiodesis. Interpreter use was associated with delayed follow-up, whereas insurance status, MyChart activation, ADI, and COI were not. Increasing delay was associated with overcorrection, including unplanned surgery for overcorrection in patients with very delayed follow-up. Future studies should evaluate targeted strategies to improve and ensure timely follow-up for guided growth procedures. Level of Evidence III Key Concepts (1) Timely follow-up after temporary hemiepiphysiodesis is essential since delayed surveillance was associated with overcorrection and unplanned surgery. (2) In a predominantly low-opportunity urban cohort, interpreter use was associated with delayed follow-up, whereas ADI, COI, insurance status, and MyChart activation were not. (3) Only 55% of patients returned within 3 months after temporary hemiepiphysiodesis in this urban pediatric cohort.