Guided growth surgery

Who is the leaflet for?

This leaflet is for parents and carers to prepare you and your child for leg alignment surgery using a technique called guided growth.

What is the aim of guided growth surgery?

The aim of guided growth surgery is to improve the alignment of your child’s legs.

Why is this surgery needed?

Your child has an angular deformity in one or both legs. This could be at the knee or ankle level. The surgery will be performed at the location of the problem.

It is commonly performed for ‘knock knee’ deformity (genu valgum) and ‘bow leg’ deformity (genu varum). This is where there is an angular deformity at the knees.

The deformity may be caused by a problem in the lower end of the thigh bone (femur), top end of the shin bone (tibia) or a combination of both. The guided growth plate(s) is inserted at the site of the deformity.

The plate prevents growth on one side of the bone. The other side of the bone continues to grow, leading to straightening of the bone and hence ‘guided growth’. Once the bone is straight, the plate is removed.

What does guided growth surgery entail?

The surgery is performed under a general anaesthetic. The guided growth plates will be inserted where the deformity is. Your surgeon will discuss this with you before the operation.

Each guided growth plate takes 40-60 minutes to insert.

There will be a scar approximately 6cm in length at the site of each plate. Your child’s legs will look exactly the same before and immediately after surgery. The legs ‘grow straight’ with time. The length of time this takes will depend on the severity of the original deformity and the speed of the child’s growth.

Your child is sometimes discharged the same day as surgery. More commonly, your child will go home the day after surgery.

What does removal of guided growth plate surgery entail?

Once the legs are straight, or slightly over-corrected, the guided growth plates will be removed. We often wait for slight ‘over-correction’ of the leg alignment to allow for some rebound growth once the plates are removed. The plates will be removed under general anaesthetic which takes a similar length of time to insertion. The same scar will be used. Occasionally the scar needs to be slightly enlarged.

Prior to surgery

Your child will be seen in the pre-assessment clinic by their surgeon and a physiotherapist.

You will have the opportunity to ask any questions. Their surgeon will explain the benefits and risks of surgery and any alternative treatments available. They will ask you to sign a consent form for the surgery to be performed.

You will be informed about when your child needs to stop eating and drinking before surgery.

Your child will need paracetamol and ibuprofen for pain relief after the surgery. This will not be supplied by the hospital.

On the day of surgery

You will arrive on the admissions ward at the designated time which you will be informed about in writing and /or a phone call from the bookings coordinator.

You will meet your child’s surgeon and will be able to ask any questions.

The site for surgery will be marked on your child’s leg/s. You will meet the anaesthetist who will look after your child whilst they are asleep.

Can my child walk after the surgery?

Yes, but it may be uncomfortable for a few days. Your child will be given crutches to make this easier. Most children discard these within a week of surgery.

Dressing and wound management

Dissolving stitches (under the skin) and steristrips are used to close the wounds.

A small adhesive dressing will be covering the surgical wound sites. A bigger outer padded bandage will cover these dressings. The bulky bandage can be removed after two days. Keep the dressings clean and dry for 10-14 days. You will need a wound check at 10-14 days. You will be advised where this will be performed.

Pain relief

Give regular paracetamol and ibuprofen for a few days. This can then be gradually reduced.

Your child may be sent home with Oramorph (liquid morphine) for breakthrough pain for the first three to seven days.

Showering / bathing

Your child can have a bath or shower once the wounds are healed and dry, usually 10-14 days after surgery.

When can my child return to sports?

Swimming can start after three weeks if the wounds are dry and healed.

Sports can be restarted six weeks after surgery

Schooling

Your child can return to school when they are comfortable. For most children this is after two days.

Follow up

Your child’s wounds will be reviewed 10-14 days after surgery in the outpatient clinic or at your GP surgery. A follow up clinic appointment will be arranged with your surgeon. X-rays will be taken to monitor your child’s leg alignment.

Contacts / Further information.

Clinical nurse specialist for Paediatric Orthopaedics.
01223 254996- answerphone available.
Bleep 159 127 via Addenbrooke’s switchboard on 01223 245151.
Email the Paediatric Orthopaedic nurse

Secretary for Paediatric Orthopaedics.
01223 216101- answerphone available.
Email the secretary for Paediatric Orthopaedics

Paediatric Orthopaedic Physio team.
Email the Orthopaedic Physio team

Ward F3.
01223 217567.