INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 05,2025
Journal:
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HEMIEPIPHYSIODESIS IN PEDIATRIC ORTHOPAEDICS AS A TREATMENT OF
KNEE DEFORMITIES
Muhammadiev Sobirjon Uchqunjon ugli
Abstract:
Hemiepiphysiodesis is a growth modulation technique widely used in pediatric
orthopaedics to correct coronal plane deformities of the knee, including genu valgum and
genu varum. The procedure involves temporary tethering of one side of the growth plate
(physis) to harness the remaining growth potential and gradually realign the limb. Compared
to osteotomies, hemiepiphysiodesis is less invasive, associated with fewer complications, and
allows for gradual correction with minimal discomfort. This review outlines the anatomical
principles, biomechanical rationale, surgical techniques, patient selection criteria, and
postoperative follow-up protocols. Additionally, it addresses the limitations and potential
complications of the procedure, emphasizing the importance of surgical timing and precise
deformity analysis for optimal outcomes.
Keyword:
Pediatric orthopaedics, hemiepiphysiodesis, growth modulation, genu valgum,
genu varum, physeal tethering, 8-plate, coronal deformity correction, guided growth surgery.
Angular deformities of the knee joint, particularly genu valgum (knock-knee) and genu
varum (bow-leg), are among the most common orthopaedic conditions in children. While
many cases of physiologic deformity correct spontaneously with growth, persistent or
progressive deformities may impair gait, induce pain, and predispose to patellofemoral
maltracking, joint instability, and early-onset osteoarthritis. Surgical correction is indicated
when the deformity is symptomatic, progressive, or exceeds physiological norms for age.
Historically, corrective osteotomies were the standard of care; however, they are invasive,
carry significant morbidity, and often require prolonged rehabilitation. In contrast,
hemiepiphysiodesis
, a procedure that modulates growth by asymmetrically arresting one side
of the growth plate, offers a less invasive and reversible means of correction. This approach
capitalizes on the child’s remaining growth potential and has evolved from early staple
fixation to modern tension-band plating systems, such as the 8-plate, which provide more
controlled and safer correction.
The growth plate (physis) is a cartilaginous structure responsible for longitudinal bone
growth in children. Angular deformities can arise due to asymmetrical growth from either
intrinsic physeal abnormalities or external mechanical stresses. Hemiepiphysiodesis works by
inhibiting growth on one side of the physis, allowing the contralateral side to grow freely.
Over time, this results in angular correction toward the mechanical axis.
This principle was first established by Phemister and further refined by Blount and Stevens,
who introduced guided growth using flexible plating systems. The correction rate depends on:
Patient age (younger children correct faster)
Remaining growth potential
Location of deformity (distal femur vs. proximal tibia)
Etiology of deformity (idiopathic, metabolic, post-traumatic)
Hemiepiphysiodesis is primarily indicated in skeletally immature patients presenting with
coronal plane deformities of the knee, such as genu valgum or genu varum, that are
symptomatic, progressive, or exceed normal physiological alignment for age. Early
INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 05,2025
Journal:
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intervention is particularly valuable in cases with significant deformity likely to result in
mechanical axis deviation, which can lead to gait disturbances, patellofemoral instability,
pain, and early degenerative joint changes if left untreated. Ideal candidates are typically
children with at least 12–18 months of growth remaining, in whom gradual correction
through growth modulation is feasible. Underlying etiologies may range from idiopathic
deformities to pathological causes such as Blount disease, rickets, skeletal dysplasias, and
post-traumatic physeal disturbances. It is critical to differentiate between physiologic variants
and pathologic deformities, with the latter often requiring closer monitoring and more
aggressive management.
The decision to proceed with hemiepiphysiodesis must account for the site of the deformity
(distal femur, proximal tibia, or both), the degree and direction of angular deviation, and
skeletal maturity. Long-standing anteroposterior standing radiographs of the lower limbs are
essential for precise preoperative planning, enabling calculation of the mechanical lateral
distal femoral angle (mLDFA) and medial proximal tibial angle (MPTA), which inform the
level and side of the intervention. Deformities affecting both the distal femur and proximal
tibia may require dual-level hemiepiphysiodesis. Additionally, growth prediction tools such
as the Green-Anderson growth remaining chart or the Paley multiplier method assist in
determining the optimal timing of intervention to achieve full correction without
overcorrection.
Once surgical indication is confirmed, the operative procedure of hemiepiphysiodesis using a
tension-band plate system, such as the widely used 8-plate or peanut plate, involves a
minimally invasive approach. Under general anesthesia and fluoroscopic guidance, a small
skin incision is made over the physis on the convex side of the deformity. The periosteum is
gently elevated, and a two-hole plate is centered over the physis, with screws placed in both
the epiphyseal and metaphyseal segments without crossing the physis itself. The tension-band
construct functions by tethering one side of the growth plate, allowing the contralateral side
to grow uninhibited, gradually realigning the limb over time. The choice of implant size and
screw length must be age-appropriate and individualized based on bone size and quality.
Both unilateral and bilateral procedures can be performed simultaneously, depending on the
symmetry and extent of the deformity.
Postoperative management focuses heavily on structured follow-up and radiographic
monitoring. Patients are typically allowed full weight-bearing immediately after surgery, and
return to normal activities, including sports, is often rapid. The key to successful correction
lies in regular clinical and radiographic evaluation, usually every 3 to 6 months, to track the
rate of angular correction and detect potential complications early. Radiological assessment
includes full-length standing films to determine mechanical axis alignment and angular
measurements. The expected correction rate ranges from approximately 0.5° to 1.5° per
month, depending on the anatomical site (correction is faster at the distal femur than the
proximal tibia), patient age, and etiology. Implant removal is indicated once the desired
mechanical alignment is achieved, to prevent overcorrection. Delays in hardware removal
may result in rebound deformity, especially in cases of metabolic bone disorders or when
intervention is performed at a very young age. Thus, precise timing of both implantation and
explantation is crucial for optimal outcomes.
Conclusion
Hemiepiphysiodesis represents a cornerstone in the management of coronal plane deformities
of the knee in growing children. By harnessing the natural growth potential of the physis, this
INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 05,2025
Journal:
https://www.academicpublishers.org/journals/index.php/ijai
page 227
minimally invasive technique allows for gradual, controlled, and reversible correction of
angular misalignments such as genu valgum and genu varum. Compared to traditional
osteotomies, hemiepiphysiodesis offers several advantages, including shorter recovery time,
reduced surgical morbidity, and the ability to fine-tune correction through close monitoring.
Success relies heavily on appropriate patient selection, accurate timing based on remaining
growth, precise implant placement, and diligent postoperative follow-up. While
complications such as rebound deformity or overcorrection can occur, these are largely
preventable with proper surgical technique and monitoring protocols. Ultimately,
hemiepiphysiodesis exemplifies the principle of guided growth and serves as a safe, effective,
and patient-friendly approach in the pediatric orthopaedic surgeon’s armamentarium for
deformity correction.
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3. Burghardt RD, Herzenberg JE, Standard SC. Temporary hemiepiphysiodesis with the
eight-Plate for angular deformities: mid-term results. J Orthop Sci. 2010;15(5):699–704.
4. Shabtai L, Specht SC, Herzenberg JE. Adolescent idiopathic genu valgum correction
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techniques, and outcomes. Orthop Clin North Am. 2020;51(1):27–38.
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