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    Surgery: Knock Knees / Bow Legs

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

    Knee axis correction

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    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.

    When it is used

    Pathological knee deviations in children with useful remaining growth. Indication and timing do not depend on a fixed chronological threshold, but on remaining growth and skeletal age, site and severity of the deformity and expected rate of correction.

    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.

    When it is used

    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.

    Recovery Pathway (indicative)

    Note: This is an indicative pathway, personalised after surgery. Some elements are relatively stable (goal of the procedure, approximate hospital stay, presence of a cast or brace); others depend on the individual case (weight bearing, range of motion, imaging, sport, hardware removal, follow-up intervals) and on the surgical technique chosen.

    1. Hospital stay

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

    2. First weeks

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

    3. Second month

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

    4. Third month

      Hemiepiphysiodesis: correction takes months and is faster the more growth remains. Radiographic checks at individualised intervals.

    5. Return to sport

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

    6. Follow-up

      Hemiepiphysiodesis: periodic clinical and radiographic checks until correction, at intervals individualised to the expected rate of correction, then plate removal (brief second procedure). Osteotomy: scheduled checks over the following months, based on healing.

    Possible Complications

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

    For parents

    Knock Knees / Bow Legs: condition information page

    Causes, diagnosis, conservative options and when surgery is considered.

    Questions about this surgery?

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