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Osteotomy is a common well-established correction surgery performed to correct bow legs.
Genu varum, as bow legs are referred to, in medical terminology, is a common condition characterized by bow shaped legs, curved outwards and widely spaced knees, even when feet are placed together. It is a limb deformity which can be corrected with surgery.
Bow legs are caused due to an underlying medical condition such as rickets, paget's disease, blount's disease amongst others. Presence of bow legs even after 2 years of birth is abnormal. If left untreated, may lead to arthritis of the knee or hip.
Majority of people with Genu Varum or bow legs resulting from some pathology or disease, do not respond to non surgical treatment and therefore often require surgery.
If one has bow legs on both sides, the bow leg surgery for each leg is done at different times, preferably at a gap of 2 to 3 months at least.
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A1 A type of deformity of legs characterized by outwardly curved bow shaped legs and wide apart knees, even when feet and ankles are positioned together. In medical terminology, it is also known as Genu Varum. It is a common condition in infants and toddlers, however, occasionally can be seen in adolescents also, who are remarkably obese.
A2 Bow legs are caused by the following:
May be present in both toddlers and adolescents.
Cause: Abnormal growth plate in upper part of Tibia (Shin bone). It is also known as Tibia Vara. Growth plates are present at the ends of a child's long bones. They are responsible for the length and shape of the adult bones.
Impossible to differentiate it from Physiological (normal occurring) Genu Varum (bow legs) in children less than 2 yrs of age. However, unlike physiological bowing of legs, bow legs due to Blount's disease will deteriorate over time. As a result, when the child approaches 3 yrs of age, it could be identified well on X- rays.
Softening and weakening of bones of children
Due to Nutritional Deficiency of Vitamin D.
It could be Genetic as well which leads to poor Vitamin D absorption.
It is a metabolic disease
Under normal conditions, new bone tissue replaces the old bone tissue. However, in case of Paget's disease, this recycling mechanism of the bone tissue is disturbed leading to fragile or bent bone.
Dwarfism: Achondroplasia, a bone growth disorder, the most common type of dwarfism that eventually results in appearance of bow legs.
Bone fracture with improper healing
Bone dysplasia, with faulty development of bones
A3 It is very easy to recognize bow legs. When feet are placed together, knees appear to be positioned wide apart and legs appear to be bow shaped outwardly. Most of the time, bow legs condition starts to improve when the baby turns 12 to 18 months of age.
However, if the condition stays or worsen beyond 2 years of age in a child, you must see orthopedic surgeon for the best treatment option for the child.
The orthopedic surgeon will be able to assess the severity of deformity, the underlying cause of the condition and the best treatment option for it.
After thorough clinical examination, your doctor is most probably going to assure you and ask you to wait and watch in case of presence of symmetrical bow legs in an otherwise healthy child below 2 yrs of age.
In case he feels that there is asymmetrical bowing of legs, he may prescribe an X ray of the lower legs of the child in a standing position. Your doctor may order some blood tests or other imaging tests to look for the underlying disease. He may take your leg measuments and observe your walk.
A4 Unusual walking pattern and also, leg appearance. However, it does not impact the ability of the child to crawl, walk or run.
It does not usually causes pain or discomfort. However, persistent and worsening bow shaped legs do put stress on the joints such as hip, knee and ankle thereby causing discomfort eventually.
At times, when the bow legs are coupled with intoeing or Pigeon toes (inward pointing toes), it may lead to frequent tripping of the child which normalizes with passing time.
A5 In infants and toddlers younger than 2 yrs of age, no treatment is usually required.
Treatment for them is indicated only if some underlying medical condition is identified. Severity of the bow legs and its progress over time also determine its treatment option. Treatment of the underlying medical condition responsible for bow legs, is given.
Braces, cast or corrective surgery are the various options and the best treatment option for the patient is determined by the specialist.
A6 Not exactly. However, you may prevent certain medical conditions that are responsible for occurrence of bow legs such as Rickets. Adequate intake of Vit D will prevent occurrence of rickets and thereby bow legs.
If you child has bow legs beyond the age of 2years, please do consult the orthopedic specialist.
A7 98-99% is the success rate of the bow leg correction surgery.
A8 Your orthopedic surgeon will determine if you are going to benefit from the surgery or need it in the first place. They usually take into consideration the intensity of the deformity and evaluate each patient thoroughly.
The most important indications for the osteotomy surgery for correcting bow legs are:
If the deformity is severe, causing symptoms such as abnormal gait, aesthetically in bad shape and causing osteoarthritis.
Progressively worsening and not responding to conservative (non surgical) treatment
A9 To correct the angular deformity and realign the axis of the lower limb, femur and Tibia.
A10 Osteotomy(Osteo-bone + tomy-cut= bone cutting) is a surgery that is characterized by cutting of bone.
The purpose of cutting of bone may be to lengthen the bone, shorten the bone or proper alignment of the bone.
A11 It takes around 1.5 to 2 hours. It may vary from patient to patient, though.
A12 3 to 6 months are needed to walk normally and achieve full range of motion. High impact activities may be done only after an year or so. Please consult your bone and joint specialist to know exactly what time you may require to resume high impact exercise or activity.
A13 2 to 3 weeks
A14 Usually, 3 to 4 days
A15 The following criteria is usually adhered to, while deciding a suitable candidate fot High Tibial osteotomy surgery:
Young and active patient
Good vascular status
Daily activities are being compromised due to pain or other symptoms
Patient is not obese
Patientis otherwise fit for the surgery
Patient compliance to follow the after surgery protocol for favorable outcome is important.
A16 HTO surgery involves cutting the tibia bone(surgical fracture) not completely, but only 3/4th across the bone, in top and medial/inner part of tibia which is just below the knee.
In that gap, a bone graft wedge(a piece of bone) is inserted and secured with screws and plates and the surgical wound is closed.
Your specialist will take precise measurements of the bones, the malalignment and even the size of the bone graft which needs to be inserted and align the bones correctly before securing them in place.
The bone graft is taken from another bone of the patient himself, usually it is the pelvic bone. This kind of the bone graft is referred to as an autograft.
Although there are other types of bone grafts as well, depending upon the source of bone such as allograft (bone graft taken from another person, usually taken from bone banks that preserves the bone harvest from cadavers) and artificial or synthetic bone grafts.
The most commonly used is the bone graft from the patient himself as they facilitate bone growth and healing.
High Tibial Open Wedge Osteotomy, as explained earlier, wherein a piece of bone is inserted in the upper medial part of the shin bone and secured in place, ensures that the signs and symptoms of bow legs are relieved.
Dr Ravi Sauhta
Head - Orthopaedics & Chief - Joint Replacement & Arthroscopy
Artemis Hospital, Delhi-NCR, Gurgaon
Dr Manoj Padman
MBBS, MS (Orthopedics), DNB (Orthopedics), MSc Research (UK),
FRCS (Glasgow), FRCS (Trauma and Orthopedics)
Director, Pediatric Orthopedics
Madhukar Rainbow Children's Hospital, Delhi
Dr Nargesh Agarwal
MBBS, MS(Orthopedics), Fellow Pediatric Orthopedics, JPOA(Japan), COC
Consultant, Pediatric Orthopedics
BLK Super Speciality Hospital
Dr Ashok Rajgopal
MBBS,MS (Orthopedics),MCh (Orthopedics), FIMSA, FRCS
Institute of Musculoskeletal Disorders and Orthopedics
Medanta Medicity, Delhi NCR, Gurgaon
Dr SKS Marya
Chairman, Bone and Joint Institute
Medanta Medicity, Delhi NCR, Gurgaon
Dr. Anil Raheja
MBBS, MS(Ortho), MCh(Ortho)
Senior Consultant - Orthopaedics
Apollo Spectra Hospitals
Dr Bhushan Nariani
Director, Joint Replacement
BLK Super Specialty Hospital, New Delhi
Saket, New Delhi
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