Adolescent Blount’s Disease Surgery

 What is Adolescent Blount’s Disease?

Blount’s disease is a problem of the legs that gets worse as a child age; it is relatively easy to cure in kids with multiple years left to grow, and more difficult in those that are done or nearly done growing. Blount’s disease is divided into two categories- infantile and adolescent. Infantile Blount’s disease is much less common and is typically noticed around the age of three when a child should begin to grow out of natural bowlegs; in this type, both legs are usually affected and it is usually more severe. Adolescent Blount’s disease becomes evident over the age of ten and is more likely to affect one leg, however, some cases do affect both. Adolescent Blount’s disease impacts the top of the tibia bone and the lower part of the femur.

What Increases the Risk of Developing Blount’s Disease?

Obesity is the known risk factor for Adolescent Blount’s Disease.  However, it also affects some kids who are not overweight. Excess weight puts pressure on the medial (inside) part of the growth plate. This causes the lateral (outside) part to grow at a faster pace than the medial portion, leading to the bowlegged shape.

How is Adolescent Blount’s Disease Treated?

Using braces or continuing to watch the growth for further development is unsuccessful in adolescents, so Blount’s disease is treated using surgery. The surgical options vary based on whether the growth plates have closed, which happens around the age of puberty. The surgical technique used when the growth plates have not closed is called a hemiepiphysiodesis. It is important to notice Blount’s disease early when the growth plates have not closed since this surgery is comparatively smaller to the surgery used when the growth plates have closed. A hemiepiphysiodesis is a technique that closes the growth plates on the lateral (outside) of the leg using a metal plate and screws and gradually corrects the leg over time. Temporary closure of the growth plate allows for the temporary cessation of growth on the outside of the bone and gives the inside part of the bone an opportunity to catch up and balance out the growth disparities. After the surgery, it is vital for the patient to follow up every three months, so the growth of the bones can be monitored. Once the bones are straight and the weight-bearing forces are in the center of the knee, the plates are removed. This procedure is effective, however, about one in twenty cases will see a recurrence which is then treated with a repetition of the surgery.

Patients with closed growth plates require a different surgical technique to treat Blount’s Disease. It is called an osteotomy. An osteotomy is more complicated than the technique used when growth plates are open because this procedure involves cutting through the bone. After cutting through the bone, the appropriate correction is made to center weight-bearing forces in the knee. These corrections are then stabilized using a larger plate and more screws (than what is used for a hemiepiphysiodesis) to hold the correction. The plate and screws usually stay in the patient forever after placement. Hardware is removed for a few reasons; perhaps if a screw is causing a symptom or if the military insists a recruit must have the hardware removed to enlist.

What is the Recovery Time?

Patients can start weight bearing (walking) on the affected leg(s) on the day of hemiepiphysiodesis surgery. Bandages are removed for a shower the day after surgery. She will be provided crutches and will use them to assist weight bearing until it is comfortable to walk without using the crutches. Some patients are comfortable walking without the crutches a day or two after surgery; some patients need more time. Full activities can usually resume after approximately six weeks.

The recovery time for an osteotomy is longer than for hemiepiphsiodesis. The patient is unable to go to school until they are able to use the bathroom without assistance. The time needed to return to school varies based on weight, if one leg or both legs were operated on, and other factors. Three weeks after the surgery, the patient will come in and have their stitches taken out. After this visit, patients are given further instruction on when they are allowed to begin weight bearing and working out. The estimated recovery time to return to normal activity after an osteotomy is around three months, but again it varies from patient to patient and depends on a variety of factors. The difficulty of this surgical correction and the extended recovery time demonstrates the importance of noticing this problem earlier. A hemiepiphysiodesis may seem like a big surgery when the option is presented, but getting that surgery done when the patient is growing will prevent the necessity for a more difficult surgery later on.

What Happens if Blount’s Disease Goes Untreated?

When Blount’s disease is not corrected the patient experiences affects from this disease further down the line, if not in adolescence. Numerous adolescent patients come in complaining of knee pain, and if not corrected it will worsen. Adults who did not receive surgical corrections for Blount’s disease suffer from knee pain and develop arthritis. Untreated Blount’s disease also increases the risk of having meniscus tears and other ligamentous tears from the incorrect distribution of forces affecting the knee.

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602 Vonderburg Dr #103, Brandon, FL 33511

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