Knee Deformities

Knee deformities are frequently concerning, especially in developing kids and teenagers. There are two kinds of these: bow legs, which have a space between the knees as one stands, and knock knees, which have the knees in contact.

Deformity of the knock knee
This is a typical issue. Milder abnormalities are barely perceptible, especially if the wearer is dressed to the ankles. However, even modest knock knees (defined as distorted more than 3 degrees on a specific long leg x-ray from hip to ankle) have an impact on knee life.

Similar to an improperly positioned automobile tire, the medial side of the knee begins to wear down early over time as a result of heavy stress on that side. The patient experiences persistent, low-grade pain and discomfort as a result. This can cause more harm if left untreated at this point, and eventually these knees develop deterioration that necessitates replacement surgery.

Even while wearing clothing that reaches the ankles, knock knees are more noticeable. There is frequently an irregular gait. Even if it's only a cosmetic issue in the beginning and few people give it any thought, arthritis ultimately develops and the knee starts to hurt. Many individuals seek medical assistance after their knock knees have progressed to the point where the deformity has worsened outside of the joint, causing the knee to deteriorate further. These people are candidates for surgery right away.

The following criteria can be used to classify the therapy of knock knees:

Children's knock knees: Up to the age of eight, practically all kids have some sort of knock knee deformity. With growth, the majority of these recover.

Adolescents that experience knock knee deformity during their pubertal development spurt are known as knock knees. It is more prevalent in women. Cosmetic procedures are the most prevalent reason to consult a physician.

Middle-aged knock knees: Many patients, especially women, have minor knock knees, but by the time they are 30 to 40 years old, they begin to have knee discomfort. As they gain weight, this might occur. When pain occurs, it means that a joint is becoming overworked. In most cases, such patients would require surgical treatment.

When is someone diagnosed with a knock knee?
That's simple to figure out. You are wearing your underpants as you stand in front of a mirror. Bring both of your legs together. You have knock knees if both of your knees collide while your feet remain apart. A standing long-leg x-ray, also known as a hip-knee-ankle x-ray on the same film, can be used to measure it precisely. Only a few facilities are able to perform this task, which requires specialized software.

If someone has knocked knees, what should they do?
You may ignore it and it will go away in youngsters under ten. The patient must consult a knee specialist beyond this age. To record the degree of knock knees and any potential causes, the physician would perform certain x-rays and blood testing. You are likely to experience early knee wear-away if your knock knee is severe. It is obviously a cosmetic issue that needs fixing.

Surgery is the method of correcting the malformation. Three surgical techniques are now popular for treating knock knees (see table for comparison):

1. Growth modulation:
This method involves controlling the growth center of the inner side of the thigh bone so that it is forced to halt its growth for a while. This is accomplished by clamping it to stop its growth. After a while (typically a year or two), when the outer side keeps growing and the inner side stops, the growth evens out and the deformity is fixed. Surgery is used to do this, and it entails placing an implant—such as plates or staples—over the developing portion. After the increase is compensated, the same is eliminated. The term comes from the fact that the limb's development is somewhat controlled.

This surgery's main side effects are that
(a) at least two operations are necessary;
(b) it can only be performed if enough growth potential is left (10 to 14 years of age);
(c) the correction takes time to manifest; and
(d) there is some degree of uncertainty regarding over and under correction.

In order to remove staples, a second operation is necessary. The good news is that the youngster may continue with his regular activities without the need for plaster or bone cutting.

2. Corrective osteotomy:
This ancient open surgical procedure realigns the bone that was sliced at the lower end of the thigh bone. It requires a 3 to 4 inch incision, and to maintain the bones in their proper place, an internal fixation device (plate or rod) is typically utilized. A large scar is the main adverse impact. Usually, plate removal necessitates further surgery. Any operation involving a joint may have additional side effects, such as stiffness, non-union, delayed union, or malunion. It does require six to eight weeks of relaxation in order to heal. The advantage is that it can be repeated by mediocre hands because it is performed under direct eyesight.

3. Key-hole surgery:
We developed this technique in response to two major drawbacks of the above conventional methods:
(a) both require two operations, one for implant implantation and one for removal;
(b) the scar is not aesthetically pleasing;
(c) the correction takes a long time, requiring a lengthy follow-up in the first method; and
(d) there is a chance of additional complications.

This key-hole surgical approach uses an osteotome to weaken the bone from the inside at the crucial location through a 1 cm incision. The bone is simply fractured with force after it is sufficiently weakened. It's like breaking a plant's tender stalk. At this point, the bones may be moved into their proper positions. In the operating room, a video x-ray equipment known as the C-arm is used to monitor the location of weakening and the repair that has to be made. A well fitted plaster is put from the groin to just above the ankle after the surgeon is happy with the adjustment. In the unlikely event that the correction is inadequate, it may be easily fixed by removing the plaster, making the necessary corrections, and then applying a fresh layer of plaster. Since there isn't a foreign implant within the body, removal requires no second operation. After two and four weeks, x-rays are taken to check the position of the bones (done at home using a portable x-ray equipment).

Plastering for three to four weeks is the technique's biggest drawback. Additionally, it takes another three to four weeks for the bones to solidify before the patient may place the leg on the floor. For patients receiving treatment on both sides simultaneously, this bed rest phase becomes quite tiresome. For six to eight weeks, they will have to stay in bed. Less than 5% of the time, the bones may shift inside the plaster, necessitating either formal open surgery as in option 2 or reapplying the plaster while under anesthesia. In rare cases, the knee becomes more rigid than anticipated, necessitating manipulation under anesthesia rather than surgery.

It is a keyhole technique, and the surgeon's expertise level is crucial. The limb's neuro-vascular structure might be harmed, which would be a significant consequence that would require immediate surgical repair of the injured artery. This has only occurred once out of 90 instances in the author's experience. After undergoing repairs, the aforementioned youngster recovered. For this last reason, the author has not encouraged others to employ this method.

However, given all the other advantages listed above, it remains a popular choice in the author's opinion, especially for young girls who do not wish to trade off their deformity for an unattractive scar.

The following is the standard process:

1. The hospital does some specialized x-rays.

2. On the morning of the procedure, you are admitted. The procedure is occasionally performed throughout the day. It takes around forty-five minutes on both sides and is performed under general anesthesia.

3. Your legs would be in a plater cast from groin to ankle right after the procedure. To make sure the bones are in the proper place, a check x-ray will be taken.

4. Following a 48-hour hospital stay, you will be released from the hospital. For six to eight weeks, you will have to do all of your everyday tasks while completely bedridden. The most difficult aspect of this otherwise excellent therapy approach is this.

5. With the right preparations, one can go by rail, automobile, ambulance, or airplane. It is feasible for out-of-country patients to return home immediately after surgery, however it is preferable for out-of-country patients to remain in Delhi for ten days. We'll assist in finding appropriate housing. After ten days, if the x-ray is good on the tenth post-operative check, patients from overseas and those who live far away will be allowed to depart.

6. Within the first 10 days (1/20 instances), the bone position may vary, necessitating a change in plaster while under anesthesia and a brief hospital stay. Although it is unlikely that the bones would move beyond ten days, x-rays must be taken every ten days for the first month (days 10, 20, and 30).

7. Depending on the age, the plaster is stored for four to six weeks. Since the cut is merely 1 cm, there is no need to remove the stitches. The patient will remain in bed for an additional two weeks after the plaster is removed, but they will be able to move their knee but not walk.

8. Under the supervision of a physiotherapist, the patient will be trained to walk with the use of crutches or a walker after eight weeks. The support will be required until the wound heals, which normally takes three months after surgery. The knee might not be able to flex properly for a few more weeks. Feeling fit can take a few more weeks.

In rare cases, open surgery and plate and screw fixation may be required if the bone position changes and is outside of permissible bounds (1/100). With a 6-inch cut, this is a genuine open surgery that costs almost twice as much as the previous one.

Knee deformities - Bow legs

Another frequent knee malformation is bow legs. In less severe instances, it is barely perceptible, especially if one is dressed to the ankles. However, the "life" of the knee is affected by even moderate bow legs (deformed more than 3 degrees, as determined by a specific, long leg-hip to ankle x-ray). Similar to a vehicle tire with improperly positioned wheels, the medial side of the knee begins to wear down early as a result of increased stress on that side. The patient experiences persistent low-intensity pain and discomfort as a result.

If treatment is not received at this point, the damage may worsen and eventually the knee will become injured, necessitating replacement surgery.

Even with ankle-length clothing, bow legs are more noticeable. There is frequently an irregular gait.

Even if it's only a cosmetic issue in the beginning and few people give it any thought, arthritis ultimately develops and the knee starts to hurt.

Many people seek medical assistance after the bow legs have already suffered internal joint degeneration, which has caused the bowing to deteriorate further and the knee to gradually deteriorate. These people are candidates for surgery right away.

Correction of bow legs: We can consider bow legs into the following categories:

Children with bow legs: Nearly all children under the age of four have bow legs, which naturally correct as they become older. Bowlegs that continue after the age of eight typically worsen rather than go away on their own.

Adolescents who observe their legs bending during their pubertal development spurt are said to have bow-legs. It is more prevalent in women. Cosmetic procedures are the most prevalent reason to consult a physician.

Middle-aged bow legs: Many patients, especially women, have modest bow legs, but as their body weight increases in their 30s and 40s, they begin to experience pain. This means that a portion of their joint is becoming

Elderly bow-legs are a sign of age-related knee arthritis, in which the medial side of the knee sustains more damage than the lateral side, leading to deformity.

If the individual is still active after developing arthritis in his knee, he will experience excruciating bending.

When does a person become aware that they have bow legs?
That's simple to figure out. You are wearing your underpants as you stand in front of a mirror. Bring both of your feet together. You have bow-legs if there is still space between your knees. The bow-legs get worse the wider the gap. The distance between the knees is measured in "finger-breadths." A standing long-leg x-ray, also known as a hip-knee-ankle x-ray on the same film, may be used to quantify the same thing precisely. Only a few facilities are able to perform this task, which requires specialized software.

What should one do if they have bow legs?
You may ignore it and it will go away in youngsters under ten. The patient must consult a knee specialist beyond this age. To record the severity of bow legs and any potential causes, the physician would perform certain x-rays and blood testing. You run the risk of developing early knee wear if your leg bows more than three degrees. It is obviously a cosmetic issue that needs fixing.

Surgery is the method of correcting the malformation. It includes the subsequent steps:

1. By doing specialized x-rays, the surgeon would determine if the abnormality is originating in the bone above or below the knee. Corrective surgery is therefore scheduled. Two kinds of corrective surgery exist.

2. If the abnormality is discovered before the kid has experienced pubertal development, growth modulation surgery may be necessary. This involves temporarily halting the growth plate on the side that is developing more quickly by attaching a clip or tiny plate on that side. The clip or plate is taken off when the deformity has been fixed.

3. When a defect is discovered only after the pubertal growth spurt has occurred, corrective osteotomy is performed. Osteotomy is the name of the procedure. It is performed on the malformed bone, either the femur (bone above the knee) or the tibia (bone below the knee). Osteotomy is the process of strategically cutting a bone and realigning it to achieve the desired correction. Most frequently, a metallic strip (plate) is used to sustain the adjustment that has been made. Instead of using a plate, some people choose to keep the repair made with a plaster. Both legs can have the procedure done simultaneously.

KNEE REPLACMENT