Guided Growth-Deformity Correction in Genu Valgum – Our Experience

Abstract

Adolescent Genu Valgum, characterised by progressive knee valgus deformity, can significantly impair functional mobility and quality of life. This case study explores a personalised surgical approach-using corrective osteotomy and hemiepiphysiodesis-for the effective management of bilateral genu valgum, demonstrating correction tailored to the severity of the deformity. Introduction: Adolescent genu valgum, caused by idiopathic or growth-related factors, often leads to gait disturbance, knee pain, and early arthritis, requiring timely surgical correction. Accurate identification of the deformity site is essential for proper management. In this study, hemiepiphysiodesis was used for gradual correction in growing adolescents, while corrective osteotomy was performed for severe or fixed deformities. Materials and Methods: This prospective study was conducted in the Department of Orthopaedics, Government Stanley Medical College, Chennai, from 2022 to 2024. Three adolescents with progressive bilateral genu valgum and walking difficulty were included. Patients with prior lower-limb surgery or neuromuscular disorders were excluded. Clinical examination and full-length standing radiographs of both lower limbs were performed, and deformity was assessed using the lateral distal femoral angle (LDFA). Postoperatively, range of motion exercises began on day two. Patients treated with hemiepiphysiodesis were allowed early weight-bearing, whereas those who underwent osteotomy progressed to full weight-bearing only after radiological union, usually by 10-12 weeks. All patients were followed up for one year, and correction was assessed both clinically and radiologically. Results: All three patients showed significant improvement in knee alignment following surgical intervention. Preoperative LFDA ranged from 72° to 82°, and postoperative LFDA improved to 85°–88°, within the normal range of approximately 85°. One patient achieved correction with hemiepiphysiodesis alone, while one patient with severe deformity and another with residual deformity required additional neutral wedge translational distal femoral osteotomy. Overall, all patients demonstrated successful correction of valgus deformity and restoration of normal knee alignment. Conclusion: Hemiepiphysiodesis is effective in skeletally immature patients with mild to moderate genu valgum, whereas corrective osteotomy is preferred for severe deformities, residual deformity following hemiepiphysiodesis, or in skeletally mature patients. Both methods achieved satisfactory functional and radiological outcomes, underscoring the importance of selecting the appropriate procedure based on patient age and deformity severity.