Epiphysiodesis for Leg Length Discrepancy: A Cost Analysis of Drill Versus Screw Technique


Research has demonstrated similar efficacy of drill epiphysiodesis and percutaneous epiphysiodesis using transphyseal screws for the management of adolescent leg length discrepancy. A cost analysis was performed to determine which procedure is more cost-effective. Patients seen for epiphysiodesis of the distal femur and/or proximal tibia and fibula between 2004 and 2017 were reviewed. A decision analysis model was used to compare costs. Two hundred thirty-five patients who underwent either drill (155/235, 66%) or screw (80/235, 34%) epiphysiodesis were analyzed with an average age at initial procedure of 13 years (range, 8.4 to 16.7 years). There was no significant difference in average initial procedure cost or total cost of all procedures across treatment groups (n = 184). The cost difference between drill and screw epiphysiodesis is minimal. In order for screw epiphysiodesis to be cost-favored, there would need to be a significant decrease in its cost or complication rate. (Journal of Surgical Orthopaedic Advances 30(3):181–184, 2021)

Key words: leg length discrepancy, cost effectiveness, cost analysis, orthopaedic surgery, pediatric orthopaedics

Lara L. Cohen, MPH; Benjamin J. Shore, MD, MPH, FRCSC; Patricia E. Miller, MS; Michael J. Troy, BS; Susan T. Mahan, MD, MPH; James R. Kasser, MD; Samantha A. Spencer, MD; Daniel J. Hedequist, MD; Benton E. Heyworth, MD; and Michael P. Glotzbecker, MD