Epiphysiodesis

What is epiphysiodesis?

Epiphysiodesis is a surgical technique that is used to correct differences in bone length. When one leg is longer than the other, the technique is used to control the growth of the longer limb. It is a small surgery that uses either metal plates, screws, or drilling. Doing this stops the growth plate making new bone, this can be done for a limited time or permanently. An example of a metal plate can be seen in the picture below.

The temporary way of stopping growth at a growth plate is with metal work that can be removed. In stopping both side of the growth plate allows the surgeon to correct the limb length whilst you continue to grow normally elsewhere. Your child’s growth will be monitored closely by using X-rays and when the limb has corrected the plates will be removed in theatre.

Another method we use, is the growth plate can be destroyed completely using a drill. This does not allow any further growth to happen. This technique is more likely to be used in the older child with appropriate planning by the surgeon in its timing so that the limb lengths roughly equalise when the child finishes growth.

What is a growth plate?

The growth plate is the rounded end parts of the bone. In children, it generates new bone, which makes the bone grow.

What should I expect after surgery using removable metalwork?

After your child’s surgery, they will need to be encouraged to walk and move their limbs as much as they can. It is important not to stop doing this as it can get stiff and make their limb more painful. Your child may not need a walking aid if they can hold their own weight by themselves.

It will be uncomfortable, but with pain relief it will be eased. Your child will not necessarily need to stay overnight in hospital, as your surgery may be a day case. This will vary from child to child and will be discussed with you before the surgery.

What to expect after surgery using permanent drilling?

The most common place for permanent drilling is around the knee. Your child is likely to be given a knee brace to wear after this operation to support their lower limb whilst walking. It allows the knee to move but provides extra support for healing after surgery. It does not need to be worn all the time, it can be removed for bathing, sleeping and when resting. It is mainly for use during walking but can be used for additional support as needed, this will be clarified by your therapist along with the exercises in this resource.

The brace will need to be worn for 4 weeks to protect the knee as it heals. A walking aid will also be provided as full weight-bearing will not be allowed to start with.

It will be uncomfortable, but with pain relief it will be eased. Your child should not need a long stay in hospital after this type of surgery, and will be encouraged to walk and move to allow for a timely discharge home.

Will I need more physiotherapy when I go home?

This will depend on your child’s needs. Most children do not require physiotherapy on discharge from hospital. If your child has a physiotherapist in the community then they will be informed of the surgery on discharge. Your child will be reviewed by a therapist directly post-surgery to aid mobility and range of movement exercises.

Therapy exercises

This resource is designed to help you remember the exercises your child needs to complete at home after surgery.

The exercises should be done slowly and smoothly. Your child may have some pain while doing these exercises after surgery. If pain limits their ability to do the exercises, then timing them around pain relief may be helpful.

However if pain becomes worse, please seek advice from a healthcare professional and stop the exercises.

How many times should my child do these exercises?

It is recommended that each exercise is repeated 10 times and done a minimum of 3 to 4 times a day. Make sure the exercises are staggered throughout the day.

How do I manage my swelling?

Swelling is common in the first few weeks following any surgery. This can be improved in several ways:

Elevate

Always elevate your child’s leg. Proper elevation means their leg should be above the level of the heart. Use pillows or cushions at home to do this.

Cold therapy

Cold packs can be used to reduce swelling. If you use something that is frozen, this must be wrapped in a damp towel or cloth to avoid ice burns. No more than 10 minutes at a time is required for cold therapy. This can be repeated throughout the day if needed.

Exercises

Ankle pumps

Lie down on your back. Point your foot and toes down to the floor or bed. Then slowly pull your foot and toes up towards your knee. Keep your leg straight throughout.

Repeat 10 times.

Static quads (knee squashes)

Lie down on your back. Push your knee down firmly against the bed. Keep your leg straight with your foot and toes pointing upwards.

Hold for 5 seconds.

Repeat 10 times.

Knee bends

Lie down on your back or in sitting. Begin with your leg straight. Bend your knee by bringing your heel towards your bottom. Return to the starting position. You can use a plastic bag under your foot to help slide your foot back if bending the knee is difficult initially.

Repeat 10 times.