CPT® Code 27475

1. Indications

Epiphyseal arrest is indicated for the treatment of bone length discrepancies that may arise due to various conditions affecting growth. The following are specific indications for performing this procedure:

• Bone Length Discrepancy The primary indication for epiphyseal arrest is to correct a significant difference in length between the femurs or between the tibia and fibula, which can lead to functional impairments and gait abnormalities.
• Growth Plate Abnormalities Conditions that affect the growth plates, such as congenital deformities or previous injuries, may necessitate this procedure to manage growth and alignment.
• Leg Length Inequality Patients with leg length inequality due to various etiologies may benefit from this surgical intervention to achieve better symmetry and function.

2. Procedure

The procedure for epiphyseal arrest involves several critical steps to ensure effective treatment of the bone length discrepancy. The following outlines the procedural steps:

• Step 1: Anesthesia and Positioning The patient is placed under appropriate anesthesia, and positioning is carefully adjusted to provide optimal access to the surgical site, typically the distal femur and/or proximal tibia and fibula.
• Step 2: Incision A surgical incision is made over the distal aspect of the femur and/or the proximal aspect of the tibia and/or fibula. This incision allows access to the underlying bone structures while minimizing damage to surrounding tissues.
• Step 3: Dissection The surgeon meticulously dissects the soft tissues surrounding the bone, taking care to protect important blood vessels and nerves that may be present in the area. This step is crucial to avoid complications during the procedure.
• Step 4: Exposure of Bone Once the soft tissues are adequately dissected, the distal femur and/or proximal tibia and/or fibula are exposed. This exposure is necessary for the placement of the devices that will arrest bone growth.
• Step 5: Placement of Devices The surgeon strategically places devices such as Blount staples, transphyseal screws, or a plate and screw device into the epiphysis of the distal femur and/or proximal tibia and/or fibula. These devices are designed to temporarily halt growth at the growth plate, thereby addressing the length discrepancy.
• Step 6: Closure After the devices are securely placed, the surgical site is closed in layers, ensuring that the soft tissues and skin are properly sutured to promote healing.

3. Post-Procedure

Following the epiphyseal arrest procedure, patients typically require careful monitoring and follow-up care. Post-procedure care may include pain management, physical therapy, and regular follow-up appointments to assess healing and the effectiveness of the growth arrest. Patients are advised to limit weight-bearing activities during the initial recovery phase to ensure proper healing of the surgical site. The expected recovery time may vary depending on the individual patient's condition and the extent of the procedure performed. Additionally, the surgical team will provide specific instructions regarding activity restrictions and signs of potential complications that should be reported immediately.