Time and Travel Burden Associated with Hexapod-Assisted Correction of Lower Extremity Deformity

Background: Hexapod devices, colloquially referred to as frames, are powerful tools to correct lower extremity deformity. However, patients who undergo treatment with frames are followed closely to ensure that clinical and radiographic correction are satisfactory. Depending on the size of the state and the number of surgeons that offer frame treatment, patients may need to travel a long distance and frequently, to obtain care. We sought to characterize the number of clinical and surgical encounters, as well as the cumulative driving distance, for frame patients treated at a single academic health center. Methods: All patients treated with a hexapod frame for any etiology by three pediatric orthopaedic surgeons at a single children’s hospital over an 8-year period were investigated. Patients were queried for demographic data, number of non-surgical and surgical clinical encounters and number of days in the frame. Driving distance was calculated from the patients address to the academic health system address. Results: Thirteen patients qualified for inclusion (10 male, 3 female). Mean age at frame application was 14.6 years (range 4-31). Mean time in the frame was 150.5 days (range 90-207). Throughout the course of their frame treatment, patients had a mean of 16 non-surgical (range 5-26) encounters and a mean of 3 (range 2-6) surgical encounters. Mean one-way driving distance between the treating institution and the patient’s home was 77 miles (range 20-212 miles). When two way driving distance was multiplied by the total number of encounters for each patient, the mean distance driven was 2616 miles (range 862-7632 miles). Conclusion: In this cohort of patients with a lower extremity frame, there were on mean 16 non-surgical and 3 surgical encounters, with a mean driving distance during the treatment program of 2600 miles. When agreeing to undertake a hexapod-assisted program for lower extremity pathology, patients should be counseled about the temporal and financial nature of this strategy, so they are aware of the large commitment needed.