Overview

Differences in leg lengths can affect a child’s activity or cause uneven wearing of a joint. Epiphysiodesis is a technique used to control the growth of a bone permanently, or temporarily. Each of the long bones in the lower limbs have growth plates. Our surgeons can selectively slow or stop the growth of a bone by targeting one or more of these growth centers. Epiphysiodesis does not yield immediate results, but rather corrects limb length discrepancies gradually over time. When growth is slowed in one limb, it gives time for the leg length discrepancy to correct in the opposite limb.

Similarly, hemi-epiphysiodesis or guided growth is a technique that stops or slows one part (half) of the growth plate. This technique is used in angular deformities such as for example genu varum or genu valgum (bowed legs or knocked knees) to slow the growth on one side of the leg, allowing the other side to grow faster thereby correcting the deformity. Typically, guided growth involves placing an 8-plate (a small plate with two holes) on either side of the growth plate.

Indications / Candidacy

Candidates will be assessed by one of our surgical specialists to ensure a proper diagnosis and that all physical criteria are met. We accept both pediatric and adult patients for limb lengthening surgeries. Patients, and in some cases their care givers, must be willing to participate in physical therapy, and attend regular appointments with their physician throughout the entire limb lengthening process.

Good candidates for this procedure experience:

  • Deformity of the limb in more than one plane
  • Length difference between two limbs
  • Combination of deformity and length difference
  • Pain that affects their back, posture, hips, knees, and ankles
  • Pain that is more severe on one side of the body
  • Issue with gait or walking

Treated Conditions

The Canadian Limb Lengthening Center offers treatment of many complex orthopedic conditions. We pride ourselves in providing highly specialized expert care and a holistic approach. Epiphysiodesis and Hemi-epiphysiodesis are just some of the techniques we use to correct deformity in our pediatric patients. To learn more about the conditions we treat with a guided growth technique following the links below:

Condition

Congenital limb deficiency

Condition

Genu valgum

Condition

Genu varum

Condition

Limb Length Discrepancy

Condition

Skeletal dysplasias

Surgical Technique

EPIPHYSIODESIS

Epiphysiodesis is usually preformed as out-patient procedures (also known as same day surgery). Your child will NOT be required to stay at the hospital overnight.

  1. A preoperative assessment will include measurement of limb lengths and clinical deformities (both angular and rotational). Radiographic assessment will also be taken before surgery.
  2. During surgery a small incision is made to access the bone.
  3. The surgery can involve drilling the growth plate, placing screws across it or tethering it both sides with an 8 plate (or H plate) to prevent the bone from growing. In an epiphysiodesis both sides of the growth plate need to be slowed or stopped.
  4. In some cases, the leg can be made to stop growing at multiple growth plates, depending on the length difference.
  5. Once completed, the incision is then closed with dissolvable sutures, leaving a small scar that will heal over time.
  6. With this technique there is no need to cut the bone, which means there is no need for extensive internal or external fixation and patients typically do not require a cast or a brace after the procedure.

HEMI-EPIPHYSIODESIS

Hemi-epiphysiodesis is usually preformed as out-patient procedures (also known as same day surgery). Your child will NOT be required to stay at the hospital overnight.

  1. A preoperative assessment will include measurement of limb lengths and clinical deformities (both angular and rotational). Radiographic assessment will also be taken before surgery.
  2. During surgery a small incision is made to access the bone.
  3. The surgery can involve drilling the growth plate, placing screws across it or tethering it on one side with an 8 plate (or H plate) to prevent the bone from growing. In a hemi-epiphysiodesis only one side of the growth plate need to be slowed or stopped.
  4. Guided growth can be preformed on multiple bones (such as the femur and tibia) depending on where the deformity is.
  5. Once completed, the incision is then closed with dissolvable sutures, leaving a small scar that will heal over time.
  6. With this technique there is no need to cut the bone, which means there is no need for extensive internal or external fixation and patients typically do not require a cast or a brace after the procedure.

Results

Epiphysiodesis and hemi-epiphysiodesis can provide a more functional and comfortable experience for the future of our pediatric patients. By the time patients reach skeletal maturity the goal is that they have equal limb lengths and straight legs. With these results comes improved range of motion, gait mechanics and joint stability without having to undergo any major surgery or breaking of the bones (osteotomies) to fix alignment or length. In the case that an epiphysiodesis is performed for a partial correction and there remains a limb length discrepancy at the end of growth, our surgeons can use other leg lengthening surgeries to correct limb length.

Potential Complications

As with any surgical procedure, Epiphysiodesis can have difficulties and complications. While educating patients on these potential risks, we take extensive measures to avoid complications and teach patients how to properly care for their body during treatment. Our team of experts is well equipped to treat complications should they arise. Complications and side effects may include:

  • Partial or asymmetric closure of the growth plate, causing angular deformity
  • Fracture of the growth plate
  • Permanent growth plate injury
  • Joint injury
  • Rebound period of accelerated growth (upon removal of an 8plate)
  • Iatrogenic limb length inequality
  • Overcorrection or under correction
  • Hardware migration

Pre-Operative Care

  • An extensive medical history will be taken during your child’s initial assessments
  • Certain medications and vitamins may need to be stopped several weeks before
  • Discuss all medications and over the counter drugs with your surgeon
  • Use a calendar or agenda to organize your child’s pre- and post-op appointment dates
  • Plan to assist your child following surgery and throughout the guided growth process

Post-Operative Care

  • Early movement and activity are recommended as tolerated by the patient
  • The large compressive elastic bandages can be removed 3-5 days after surgery. However, the small adhesive dressings must remain in place and remain dry until your first follow up appointment.
  • If your child had an epiphysiodesis, they will be able to partially weight bear on the affected leg with crutches as soon as they are comfortable
  • If your child had a hemi-epiphysiodesis, they will be able to fully weight bear and the crutches will be used for comfort.
  • Physical therapy will be necessary for maintaining range of motion and strength for return to normal activities
  • Monitoring your child’s pain after surgery is very important. For the first week, over the counter pain medications are recommended
  • If there is stronger discomfort, we may prescribe a small amount of pain medication
  • Use pillows and other comfort supports as needed while resting. Elevate leg to reduce swelling

Follow-ups after surgery

  • Your child’s first follow-up will be within 7 to 14 days after surgery to remove dressings and assess their incisions.
  • Follow-up radiographs are recommended every 3-6 months
  • It is of the upmost importance to have regular follow-up visits with your surgeon when guided growth is performed, since the plates need to be removed once the legs are straight or the legs will continue to correct and eventually deform in the opposite direction.
  • Hardware is removed when full correction has been achieved
  • Depending on age, intermittent follow-up should continue for at least 1-2 years
  • After completed correction follow-ups may be needed annually to continue monitoring your child while they are growing

Case studies

11 year old girl with Genu valgum
11 year old girl with LLD

AM I A CANDIDATE?

Are you experiencing an orthopedic condition and would like to improve your physical capabilities?

Or you simply would like to achieve your long-lasting dream of improving your height?

Let us help you achieve your optimal health and wellness in a professional setting.

Let’s open up a discussion to help you achieve your goals.

Highly specialized expert care at CLLC

At the Canadian Limb Lengthening Centre we offer complex deformity correction and limb lengthening surgeries performed by experienced surgeons with the most up to date technologies. When it comes to your care, and treatment of deformity and limb length discrepancy, our surgeons have extensive training and experience.

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