Surgery: Knock Knees / Bow Legs

Hemiepiphysiodesis and osteotomies for pediatric knee deformity: techniques, recovery and outcomes. Dr. Priano, Milan.

Knee axis correction

Surgical Techniques

Temporary Hemiepiphysiodesis (Growth Modulation)

Minimally invasive technique using child's residual growth. Small metal plates (eight-plates) placed on one side of growth plate to slow its growth and allow spontaneous axis correction.

Indication

Pathological knee deviations in children with sufficient residual growth (generally before age 12-14).

Recovery

Full weight-bearing walking within days. Correction occurs gradually over months. Plates removed once correction achieved.

Corrective Osteotomy

Procedure involving cutting and realigning bone (femur or tibia) to correct deformity. May require fixation hardware.

Indication

Severe deformities in patients at end of growth or when hemiepiphysiodesis no longer feasible.

Recovery

Protected weight bearing with crutches for several weeks. Physical therapy for complete recovery.

Postoperative Overview

Most knee deviations correct spontaneously. Surgery is reserved for selected cases after careful clinical and radiographic evaluation.

Detailed Recovery Timeline

Note: The timeline below is a general baseline. The actual postoperative course varies depending on the specific surgical technique chosen (see procedures above).

Hemiepiphysiodesis: day-surgery. Osteotomy: 2-3 days hospitalization.

Hemiepiphysiodesis: crutches for 1 week, then normal. Osteotomy: crutches non-weight bearing for 4-6 weeks.

Hemiepiphysiodesis: normal life, avoid contact sports for 4-6 weeks. Osteotomy: progressive weight bearing, physical therapy.

Hemiepiphysiodesis: correction requires 6-18 months depending on age (faster in younger). X-rays every 3-4 months.

Return to Sport

Hemiepiphysiodesis: sports after 4-6 weeks. Osteotomy: sports after 3-4 months and radiographic consolidation.

Follow-up Schedule

Hemiepiphysiodesis: checks every 3-4 months until correction, then plate removal (brief second surgery). Osteotomy: monthly checks, then quarterly.

Possible Complications

Hemiepiphysiodesis: under/overcorrection (corrected by adjusting removal timing), plate breakage (rare). Osteotomy: delayed union, infection, neurovascular injury (rare).

For parents