A Patient’s Guide to Epiphysiodesis

The leg (and indeed the arm) grows in length because there is a growth plate (physis) at the top and bottom of both the thigh bone (femur) and the shin bone (tibia). These growth plates grow throughout childhood but will ‘disappear’ as you go through puberty and by the time you are 16-17y in boys or 14-15y in girls, you will be skeletally mature and there will be no physis left. Your spine will continue to grow but not your legs.

Epiphysiodesis is a technique used to permanently stop growth from one (or more) of the 4 growth plates in a limb to correct problems with leg length. It is commonly performed around the knee, in either the femur or tibia, and less commonly, at ankle joint level (distal part of the tibia) or at the hip joint level (top or proximal part of the femur). It must be done before you have finished growing i.e. before skeletal maturity. The timing of the procedure depends on how much the difference is between your two leg lengths: the bigger the difference, the earlier the procedure takes place and /or the more growth plates we stop.

Growth can be prevented by disrupting the growth plate by drilling it and curetting it to damage the growth plate cartilage of the physis – the area within the bone responsible for growth. This stops growth, from this one region, permanently.

Occasionally, if it is an unusual and more general condition where more than ‘just the bones’ are wrong, it is difficult to predict the correct timing of the procedure and it might be useful to perform a temporary procedure. In these cases, a small plate and screw system is inserted on each side of the bone to ‘tether’ growth for awhile. The screws and plates can be removed to allow growth to continue when the correction has been achieved.

Often, a number of epiphysiodeses can be performed at the same time to achieve the desired correction. It may be performed at the same time as corrective surgery in the hip or ankle is performed.

Epiphysiodesis is used in patients with a difference between the lengths of their legs (or occasionally, their arms). By reducing the rate of growth of the longer leg, it allows the shorter leg to catch up so that by the time you have finished growing, your legs are essentially the same length.

Permanent Epiphysiodesis

The procedure is performed as a day case under a general anaesthetic. The growth plate is identified using x-ray and a small incision is made at each side of the growth plate (on the medial and lateral sides, normally a short distance above or below the knee). If a permanent growth arrest is required, a drill is inserted into the growth plate which damages the cartilage layer. This damaged layer is then removed with a curette. After surgery, the wounds are closed with absorbable sutures and in the knee and ankle, a wool and crepe bandage is used to wrap the leg.

Following surgery, the patient is encouraged to get up and walk with use of crutches weightbearing fully if discomfort allows. 

The bulky bandage is removed at 24-48 hours, wounds should be checked at two weeks (either at clinic or with the GP practice nurse) and clinic review is usually at between six and twelve weeks.

Local anaesthetic is often injected into the wounds during surgery so that the patient wakes up comfortably and with no significant pain.

Simple painkillers like paracetamol or ibuprofen are usually all that is needed but in patients with severe pain a small dose of opiate may be necessary during the first few hours after the operation.

Strong painkillers are usually not necessary in hospital or on discharge home.

Postoperatively the patient is allowed to fully bear weight. Crutches may be provided for comfort but should not be needed for more than a few (5-7) days.