Complications of orthopedic treatment in patients diagnosed with X-linked hypophosphatemic rickets

X-linked hypophosphatemic rachitis (XLHR) manifests early in life with bone deformation.To correct associated bony deformities, the traditional approach has been surgical. XLHR can now be treated with the new antibody drug Burosumab. However, treatment with Burosumab is very expensive with an incremental cost of 3 million US dollars per patient, andthe extend of surgery and severity of complications in this patient population have not been systematically assessed in current literature. 

This study reviewed systematically the published literature describing deformity corrections and complications in patients with XLHR.  On average one complication occurred per surgery and the severity of complications were substantial. The treatment goal was not achieved in 28% of surgeries whereof half of them resulted in permanent sequalae or new pathology. Our findings support the use of Burosumab for treatment of the skeletal changes in XLHR as the reported side-effects in Burosumab treatment appear negligible compared to the impact of surgeries and related complications.