Temporary Epiphysiodesis a Unique mini-invasive outpatient surgery to correct leg length discrepancy, knock knees and bow legs
The name of this surgery may seem difficult, but the execution is very simple, fast and mini-invasive. It is called temporary epiphysiodesis, a surgical procedure that allows to stop or slow down the growth of growing cartilage.
This operation, with different procedures, is used to correct the most common problems found in the lower limbs of children and young people, such as Leg Length Discrepancy, Knock Knees or Bow Legs.
Leg Length Discrepancy has a prevalence in paediatric patients between 21 and 32% and occurs as both congenital and acquired forms.
The indication for treatment is traditionally confirmed if the degree of dysmetria is greater than 25 mm (assumed at the end of growth), while if the dysmetria is less than 2 cm, in general, no surgical treatment is needed.
Valgus knee is a condition in which the knees point inwards and almost touch each other when the child is standing with his ankles spaced. While bow legs is a very common disease in children under 2 years of age, in which, when a child is standing with his feet together, the knees do not touch each other and there is indeed a clear space between the two.
In all these cases, and in particular when facing with the hypothesis of bow legs and knock knees, observation is always the first option, because these are conditions that tend to resolve spontaneously. For example, only after the age of 7 or 8 if the degree of valgus is important and causes pain or difficulty in walking, paediatric orthopaedists can recommend treatments, surgical or not.
In the case of the bow legs, however, if it is still present at the age of 3 years, this could be a sign of an underlying bone disease and therefore may require diagnostic tests, such as an X-ray of the legs with the child standing, to determine the varus and varus angles and assess the shape of the bone part still growing. With this information, it is possible to identify or exclude possible pathologies.
The fundamental thing in all cases is always to establish the timing of surgery.
The formation of long bones begins between the second and fourth week of intrauterine life and ends when the bone reaches adult size. It is precisely during the growth phase that the above conditions can occur. And it is only in this phase that minimally invasive surgery is possible.
The temporary epiphysiodesis, in fact, can be performed while the bones are still growing. It involves the application of 8 plates across the growing cartilages, femur, tibia, or both, to cause a transient stop in bone growth. In the case of Leg Length Discrepancy, the growth of the longest limb is temporarily stopped, in the case of varus or valgus knees, instead, the growth of the bone with axial deviations is blocked asymmetrically.
The surgery lasts 15 minutes in the operating room, the patient can return home after about three hours from the operation and can start walking immediately, or when he/she feels comfortable with it. After a week, there is no symptoms or pain. It usually takes about two years to get the right correction, after which the plaque is removed.
Professor Portinaro has successfully treated several clinical cases, using this minimally invasive and very adaptable technique. It is important to establish the correct timing of the operation, both during the pre-operative phase, to forecast the potential growth spurts, and in the follow-up with close clinical and radiographic check-ups.