What is an epiphysiodesis?

What is an epiphysiodesis?

An epiphysiodesis is a way of partially stopping growth in a longer leg or arm bone by destroying the ‘growth plate’. Since the shorter limb (non-operative limb) continues to grow as before, this has the effect of allowing the shorter limb to ‘catch up’ with the longer limb. The exact timing of the operation must be carefully calculated to get the required equalisation.

What is a growth plate?

When a child’s arms and legs are growing, they do so from the growth plates at each end of the long bones such as the femur (thigh bone). Most of the growth in the leg takes place around the knee, at the bottom of the thigh bone and at the top of the shin bone.

When do legs stop growing?

On average this is around 14 years for girls and 16 years for boys. A more individualised and accurate predication can be made by checking the child’s bone age which we do by taking a non-dominant hand X-ray to see how mature the bones are.

The surgeon will calculate the expected difference in leg lengths by the time growth has finished and based on this, will discuss the options with you.

How is an epiphysiodesis performed?

It is a simple surgical procedure performed under a general anaesthetic as a day case or single night stay. Using very small incisions, a drill and currette (small sharp spoon) the growth plate is deliberately destroyed so that it no longer functions which therefore stops growth in that part of the bone.

The exact site of the surgery will be explained by the surgeon and is based on the amount of correction or ‘equalisation’ required and which segments are short.

How do you know when arm and leg growth has stopped?

Initially we use X-rays after the surgery to check that the growth plate is disappearing or fusing. Later we use clinical checks of leg length difference to confirm that the discrepancy is reducing.

What are the advantages of having an epiphysiodesis?

An epiphysiodesis is a relatively simple operation for your surgeon to perform with low risk. Scarring from an epiphysiodesis is usually small. Recovery time after surgery is quick and most children are day-cases or single nights stays.

After a short period in an unlocked knee brace with crutches, your child will be able to walk normally. They will usually be able to return to full sporting activities within 8 to 12 weeks.

What are the disadvantages of having an epiphysiodesis?

It is an operation that requires being put to sleep and has general risks such as infection, pain and stiffness.

The final result of the treatment takes time to be apparent: the shorter leg takes time to catch up with the longer leg, which has had part or all of its growth stopped.

If operating on the legs, some height is clearly being sacrificed in order to achieve equal limb lengths. Some patients may prefer to avoid loss of height by having a different type of operation to lengthen the short leg.

Some people may also think their surgeon is operating on the leg they think of as being normal or ‘good’.

What are the other methods of equalising leg lengths?

The easiest and simplest method of equalising leg lengths is for your child to use a shoe raise or insole. However many children and especially teenagers would rather have a lasting solution rather than needing to wear an orthotic for the rest of their life.

Short limbs can also be lengthened surgically but this is a more complicated treatment which takes many months to complete. This treatment has many potential complications and implications and should be thoroughly investigated and discussed before being chosen.

Longer legs in fully grown children can also be surgically shortened by removing a cylinder of the bone usually in the thigh bone (the femur) and fixing it with a metal rod, but this is extensive surgery.

Who should you talk to?

Before you decide upon a course of treatment, you should discuss them with:

• your orthopaedic surgeon
• your GP
• your physiotherapist