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.

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

After isolated hemiepiphysiodesis, walking and loading resume according to pain and the surgeon’s instructions, often within days. Correction takes months; plate removal is timed according to follow-up findings.

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 after isolated guided growth

The illustrated pathway covers isolated hemiepiphysiodesis around the knee. Osteotomy and associated procedures require their own loading and recovery plan.

Open the guided-growth rehabilitation protocol

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.

Hospital stay
Hemiepiphysiodesis: day-surgery. Osteotomy: 2-3 days hospitalization.
First weeks
Isolated hemiepiphysiodesis: crutches for comfort and loading as instructed. Osteotomy: non-weight bearing or protected loading for the prescribed period, often around 4-6 weeks, according to stability and healing.
Second month
Hemiepiphysiodesis: resume activities according to pain, wound healing and function. Osteotomy: progress loading and physiotherapy only when authorised based on union.
Third month
Hemiepiphysiodesis: correction takes months and is faster the more growth remains. Radiographic checks at individualised intervals.
Return to sport
After isolated hemiepiphysiodesis, 4-6 weeks is an approximate reference; after osteotomy, 3-4 months can only be an estimate. Pain, healing, strength and function guide return; osteotomy also requires confirmation of union.
Follow-up
Hemiepiphysiodesis: periodic clinical and radiographic checks until correction, at intervals individualised to the expected rate, then plate removal and monitoring of remaining growth for possible rebound. Osteotomy: scheduled checks over the following months, based on healing.

Possible Complications

Hemiepiphysiodesis: under/overcorrection, rebound after removal and implant problems. Follow-up guides removal timing but does not eliminate these risks. Osteotomy: delayed union, infection and neurovascular injury.

For parents

Knock Knees / Bow Legs: condition information page

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

Questions about this surgery?

Book a consultation to discuss your child's specific case.

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