title: Orthopaedic management of Hurler's disease after hematopoietic stem cell transplantation: a systematic review.
abstract: OBJECTIVE
  The introduction of hematopoietic stem cell transplantation (HSCT) has significantly improved the life-span of Hurler patients (mucopolysaccharidosis type I-H, MPS I-H). Yet, the musculoskeletal manifestations seem largely unresponsive to HSCT. In order to facilitate evidence based management, the aim of the current study was to give a systematic overview of the orthopaedic complications and motor functioning of Hurler's patients after HSCT.
  
  
  METHODS
  A systematic review was conducted of the medical literature published from January 1981 to June 2010. Two reviewers independently assessed all eligible citations, as identified from the Pubmed and Embase databases. A pre-developed data extraction form was used to systematically collect information on the prevalence of radiological and clinical signs, and on the orthopaedic treatments and outcomes.
  
  
  RESULTS
  A total of 32 studies, including 399 patient reports were identified. The most frequent musculoskeletal abnormalities were odontoid hypoplasia (72%), thoracolumbar kyphosis (81%), genu valgum (70%), hip dysplasia (90%) and carpal tunnel syndrome (63%), which were often treated surgically during the first decade of life. The overall complication rate of surgical interventions was 13.5%. Motor functioning was further hampered due to reduced joint mobility, hand dexterity, motor development and longitudinal growth.
  
  
  CONCLUSIONS
  Stem cell transplantation does not halt the progression of a large range of disabling musculoskeletal abnormalities in Hurler's disease. Although prospective data on the quantification, progression and treatment of these deformities were very limited, early surgical intervention is often advocated. Prospective data collection will be mandatory to achieve better evidence on the effect of treatment strategies.
authors.affiliation: Department of Orthopaedics, University Medical Center Utrecht, HP G 05.228, Postbus 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Marleen H
authors.initials: MH
authors.lastname: van der Linden
authors.forename: Moyo C
authors.initials: MC
authors.lastname: Kruyt
authors.forename: Ralph J B
authors.initials: RJ
authors.lastname: Sakkers
authors.forename: Tom J
authors.initials: TJ
authors.lastname: de Koning
authors.forename: F Cumhur
authors.initials: FC
authors.lastname: Oner
authors.forename: René M
authors.initials: RM
authors.lastname: Castelein
mesh_terms: D048788:Growth and Development / Q000502:physiology; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D009043:Motor Activity / Q000502:physiology; D008059:Mucopolysaccharidosis I / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D041641:Musculoskeletal Development / Q000502:physiology; D009985:Orthopedics / Q000379:methods*; D016896:Treatment Outcome