Epiphysiodesis is a minimally invasive operation to slow or stop growth at a specific growth plate. It is used to correct leg length discrepancy by slowing growth of the longer leg, or to correct angular deformity by slowing growth on one side of a growth plate.
For permanent epiphysiodesis: small incisions are made over the growth plate. The growth plate is ablated (destroyed) by drilling or curettage. For temporary (reversible) epiphysiodesis: a small plate and screws (8-plate or tension band plate) are placed across one side of the growth plate to guide growth. The procedure takes 30–60 minutes.
Epiphysiodesis is recommended for predicted leg length discrepancy (usually 2-5 cm at maturity), angular deformity correction (knock knees or bow legs) in growing children, and Blount's disease.
Shoe raise (for small discrepancies), observation, and leg lengthening of the short side (for larger discrepancies).
Bone age assessment and growth prediction charts to time the procedure correctly. Accurate prediction of remaining growth is essential.
Gradual equalisation of leg lengths or correction of angular deformity using the child's own growth. When timed correctly, excellent results are achieved.
If growth prediction is inaccurate, the final leg lengths may not be equal.
Hardware may be palpable.
Unintended complete physeal arrest causing angular deformity.
Wound infection.
Plate or screw breakage.
After temporary plate removal, growth may overshoot.
General anaesthesia. Day-case procedure.
Minimal recovery. Walking immediately with crutches for comfort. Return to school within days. Full activity at four to six weeks. For temporary epiphysiodesis, plate removal is performed once correction is achieved.
Standing alignment X-rays every six months until skeletal maturity.
Epiphysiodesis is a much simpler procedure with faster recovery and fewer complications than leg lengthening. It is appropriate when the predicted discrepancy is 2-5 cm and timing allows.
Growth prediction uses bone age (from a hand X-ray) and charts to estimate remaining growth. The procedure is timed so that the longer leg stops growing just as the shorter leg catches up.