Hemi-epiphysiodesis O plates

What is hemi-epiphysiodesis?

Hemi-epiphysiodesis is a surgical technique that is used to gradually correct an angular deformity of a long bone, for example knock knees. It is a small surgical procedure that uses either metal plates, screws, or staples. An example of a metal plate can be seen in the picture below.

The temporary way of stopping growth is using metal work that can be removed. In controlling or guiding one side of the growth plate the surgeon can correct the limb deformity whilst you continue to grow normally on the opposite side of the growth plate. Your growth will be monitored closely using X-rays and when the limb has straightened the metal work will be removed in theatre.

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?

After your surgery you will be encouraged to walk and move your limb as much as you can. It is important not to stop doing this as it can get stiff and make your limb more painful. You may not need a walking aid if you can hold your own weight by yourself.

It will be uncomfortable but with pain relief it will be eased. You do 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 your surgery.

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.

Once you have recovered from your surgery you can continue with life as normal, including sport and exercise.

Therapy exercises

This resource is designed to help you remember the exercises you need to complete at home after surgery. The exercises should be done slowly and smoothly. Some discomfort may be noted whilst doing these exercises after your surgery. If pain limits your ability to do your exercises, then timing them around your 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 I do these exercises?

It is recommended that each exercise is repeated 10 times and performed 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 leg. Proper elevation means the 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.