When is this procedure indicated?
Epiphysiodesis surgery is indicated in case of important and persistent axial deviations. The fundamental premise for proposing epiphyseal replacement is that the growth cartilage is still active and the ideal age is 11-13 years for females and 12-15 years for males.
Although it is a minimally invasive procedure, epiphyseodesis is able to significantly modify the growth of the limbs. In order to obtain the same results when the growth process is over, it is necessary to resort to more invasive interventions that require a much longer and demanding recovery such as osteotomies using plates or external fixators.
It is important to propose this intervention carefully calculating the timing of the procedure; in fact the risk of having a lack of correction (intervention performed too late) or an excessive correction (intervention performed too early) is quite high.
How is it performed?
The surgical procedure is quite simple and effective. It involves the insertion of a metal device in the shape of an 8 with relative screws percutaneously at the proximal tibial or distal femoral level. This device allows to obtain a "guided growth" slowing down the growth of the portion of the knee where it is applied and promoting the growth of the opposite compartment in order to compensate the varus or valgus deformity of the small patient. The synthesis means are kept in place for a variable period depending on the extent of the defect to be corrected.
If the axial deviation is found towards the end of growth, the possibility of exploiting the growth cartilage will be very reduced and it will therefore be necessary to resort to osteotomy surgery. This procedure consists of a surgical interruption of the bone that is repositioned in correction of the present deformity. The osteotomy is then fixed with plate and screws or external fixators depending on the habits of the orthopedic surgeon. These fixation means are removed until the bone callus closes the osteotomy focus.
Recovery after epiphyseal surgery is quite fast. After 10 days from the operation the patient gradually abandons the crutches and resumes normal activities. For the return to sporting activity, it is necessary to wait about 40 days, starting with muscle strengthening exercises and propioception.
The most frequent complications in the immediate post-operative period are related to possible superficial skin infections, the persistence of pain at the site of surgery, formation of hematomas, DVT, joint stiffness.
In the long term, complications are related to rupture of the means of synthesis, which, if not corrected, could lead to the need for more invasive interventions.