Guided Growth Surgery

Guided growth surgery helps straighten bones as a child grows. This surgery is also called hemi-epiphysiodesis. It’s used to treat bone growth problems like bowed legs and knock knees. Guided growth surgery works by guiding (tethering) one side of the growth plate on a bone as the child grows. This allows the bone to slowly straighten. Your child must still be growing for this surgery to work.

During the surgery, a small plate is placed over the growth plate (physis) on one side of the bone. The plate slows growth on that side. Over time, this helps the bone slowly straighten. Sometimes during surgery, more than one guided growth plate will be placed. Your surgeon will decide where to place the plate and how many plates are needed.

Surgery

Guided growth surgery is usually an outpatient surgery. Patients typically go home the same day as their surgery. The points below explain what to expect on surgery day.

  • Before surgery, a physical therapist (PT) will teach your child how to walk using a walker or crutches.
  • Your child will have general anesthesia (sedation). Sedation puts them to sleep. This keeps them from feeling pain during surgery.
  • The guided growth plate is small, about the size of a paper clip. It’s placed on the outside of the affected bone, over the growth plate.
  • The plate is held in place with two small screws, one on each side of the growth plate. As your child grows, the plate helps guide the bone to slowly straighten.
  • The bone is not cut during this surgery. Your child will not need a cast or brace. They will wake up with a soft dressing over the incision.

After Surgery

What to expect as your child heals from guided growth surgery:

  • They will have a small bandage over the incision.
  • They’re allowed to walk right after surgery. They may use a walker or crutches at first. They can stop using them when they can walk without help.
  • Pain control is very important after surgery.
    • For the first week, give acetaminophen (Tylenol®) and a nonsteroidal anti-inflammatory drug (NSAID) ibuprofen (Advil®) as prescribed.
    • If your child has pain that can’t be controlled, a stronger pain medicine may be prescribed for a short time.
    • Use pillows to raise the leg that had surgery to help lessen swelling.
    • Place an ice pack over the incision while the leg is raised to help with discomfort.
    • Bring pillows or blankets for comfort during the car ride home.
  • After 48 hours, they may bathe or shower as long as the clear waterproof bandage (dressing) stays in place. Leave this dressing on until the follow-up visit.
  • They don’t have any limits on movement or weight-bearing. Encourage them to move, bend, and walk. This may cause discomfort at first, but it will get better with time. Starting to move and walk sooner can help discomfort improve faster.
  • Their leg will not be straight right away. Guided growth works slowly over time. It often takes about 1 year (12 months) to see results, depending on how fast they grow and how much deformity there was before the surgery.

When to Call the Doctor

If you notice any of the following, call the Orthopedic Clinic:

  • Redness or swelling at the incision site.
  • Fever of 101° Fahrenheit (F) or 38.3° Celsius (C) or higher.
  • Increased drainage or bleeding from the incision.
  • Increased pain that doesn’t get better.

Columbus

(614) 722-5175 [Orthopedic Clinic] – Monday through Friday, 8:00 a.m. to 4:30 p.m.
(614) 722-2000 – Evenings, weekends, or holidays; ask for the orthopedist on call.

Toledo

(419) 251-2061 – Orthopedic Clinic

Follow-up

Follow-up visits are very important to make sure the bone is straightening the right way. These visits also help decide when the guided growth plate should be removed.

First Follow-up Visit

  • Usually about 10 to 14 days after surgery.
  • Surgical dressings will be removed.
  • After this visit:
    • Wash the incision each day with soap and water.
    • Don’t cover the incision. It doesn’t need a bandage.
  • For guided growth plates placed in the thigh bone (femur), your child will have a physical therapy (PT) session. This helps them return to normal activities sooner. Guided growth plates placed in other areas usually don’t require PT.

Next Follow-up Visits

  • Your child will be seen every 4 to 6 months.
  • An X-ray will be taken to check how the bone is straightening.
  • Follow-up will continue until the bone is corrected, and the plate is ready to be removed.
    • After the bone is straight, the plate is removed during an outpatient procedure. It’s important to remove the plate once the leg is straight to prevent the leg from over-correcting. Your child will go home the same day. Pain after the plate is removed is usually mild.

 

 

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