Home Pediatric OrthopaedicsBowlegs Correction (Genu Varum Correction) in India

Bowlegs Correction (Genu Varum Correction) in India

Surgical correction of bowlegs (genu varum) in children and adolescents through guided growth or corrective osteotomy to achieve normal limb alignment

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Overview

Dr. Gurudeo Kumar is Bihar's foremost expert in pediatric limb deformity correction, having successfully treated over 280 children with bowlegs (genu varum) at Arthoscenter Patna with a 96% correction success rate and excellent cosmetic outcomes. His comprehensive approach combines thorough evaluation, age-appropriate treatment selection, and meticulous surgical technique to achieve normal limb alignment and prevent long-term complications. Bowlegs (genu varum) is a condition where the knees stay wide apart when a child stands with their feet and ankles together, creating an outward curve of the legs. While mild bowlegs is normal in infants and toddlers (physiologic genu varum) and typically corrects spontaneously by age 18-24 months, persistent or severe bowlegs beyond age 2-3 years requires medical evaluation to identify the underlying cause and determine appropriate treatment. At Arthoscenter, Dr. Kumar offers the complete spectrum of bowlegs treatment from observation and bracing to advanced surgical techniques including guided growth (tension band plating/8-plate surgery) for growing children and corrective osteotomy for severe deformities or older children. The choice of treatment depends on the child's age, severity of deformity, underlying cause (physiologic vs. pathologic), and growth potential remaining. Our child-friendly facility provides comprehensive pediatric orthopedic care including pre-operative assessment with full-length standing X-rays and mechanical axis measurement, age-appropriate anesthesia and pain management, minimally invasive surgical techniques, and specialized pediatric rehabilitation programs. Dr. Kumar's expertise ensures that each child receives personalized treatment to achieve straight legs, normal gait, and prevention of future knee arthritis.

Symptoms & Indications

This surgery may be recommended if you experience:

Wide gap between knees (more than 3 inches) when child stands with feet together after age 2-3 years

Outward curving of legs creating "cowboy stance" or bowed appearance

Asymmetric bowing - one leg more curved than the other

Progressive worsening of bowing rather than gradual improvement

Difficulty running or abnormal gait pattern (waddling or wide-based gait)

Knee pain or early fatigue during physical activities in older children

Short stature or disproportionately short legs compared to peers

Associated features suggesting underlying disorder (rachitic rosary, wrist swelling in rickets)

Family history of Blount disease or metabolic bone disorders

Lateral thrust of knee during walking (knee pushes outward with each step)

Procedure Details

Duration

Guided growth (8-plate): 30-45 minutes per leg, 60-90 minutes if bilateral. Corrective osteotomy: 60-90 minutes per leg, 2-3 hours if bilateral with fibular osteotomy.

Anesthesia

General anesthesia with endotracheal intubation required for pediatric patients. Often supplemented with regional anesthesia (epidural or peripheral nerve blocks) for superior post-operative pain control and reduced narcotic requirements. Pediatric anesthesiologist monitors throughout procedure with special attention to fluid management, temperature control, and pain management protocols appropriate for children.

Preparation for Surgery

Comprehensive pre-operative evaluation includes detailed history (age of onset, progression, family history, nutritional history), thorough physical examination with measurement of intercondylar distance (gap between knees), assessment of symmetry and severity, full-length standing anteroposterior radiographs (hip to ankle) to measure mechanical axis deviation and tibiofemoral angle, and specialized imaging if needed (CT/MRI for complex deformities). Laboratory tests include vitamin D levels, calcium, phosphorus, alkaline phosphatase, and parathyroid hormone to rule out metabolic causes (rickets, renal osteodystrophy). Treatment planning involves determining whether guided growth or osteotomy is most appropriate based on child's age, remaining growth potential (bone age assessment), severity of deformity, and underlying cause. Pre-operative counseling covers expected outcomes, timeline for correction, activity restrictions, and potential need for hardware removal. Child psychology preparation and family education are essential for cooperation and realistic expectations.

Surgical Steps

Child brought to operating room and positioned supine on radiolucent operating table for fluoroscopy access

General anesthesia induced with endotracheal intubation; often combined with regional block (epidural or femoral nerve block) for post-operative pain control

Surgical site marked bilaterally (both legs) and prepared with antiseptic solution following pediatric protocols

FOR GUIDED GROWTH (8-PLATE/TENSION BAND PLATING) - Preferred for children under 13 years with growth remaining:

Small 2-3 cm incision made on inner (medial) side of knee over the proximal tibia growth plate region

Blunt dissection through subcutaneous tissue with careful protection of nerves and vessels

Periosteum (bone covering) incised and elevated to expose growth plate (physis) under fluoroscopic guidance

Guidewire placed across growth plate perpendicular to the mechanical axis under fluoroscopy confirmation

Cannulated screw inserted over guidewire on epiphyseal (upper) side of growth plate

Second screw placed on metaphyseal (lower) side of growth plate, separated by 1-2 cm

Figure-of-eight tension band plate (8-plate) positioned over both screws spanning the growth plate

Plate secured with tightening of screws to create compression force on medial growth plate

Fluoroscopy confirms proper plate position and screw placement without growth plate penetration

If femoral component present, similar 8-plate placed on medial distal femur growth plate

Wound irrigated and closed in layers; skin closed with absorbable sutures

FOR CORRECTIVE OSTEOTOMY - Used for older children (>13 years), severe deformity, or when growth plate closed:

Longer incision (4-6 cm) made over proximal tibia on medial or lateral side depending on deformity location

Muscles retracted carefully to expose tibia while protecting neurovascular structures

Fluoroscopy used to identify optimal level for bone cut (osteotomy) - typically 1-2 cm below growth plate

Pre-drilling and marking performed to guide osteotomy plane for desired correction angle

Osteotomy performed with oscillating saw or osteotome - may be closing wedge (removing bone wedge), opening wedge (creating gap), or dome osteotomy (curved cut)

Bone realigned to correct mechanical axis - goal is to shift weight-bearing line to center of knee

Internal fixation applied with pediatric plate and screws (locked or non-locked depending on bone quality)

Fluoroscopy confirms satisfactory alignment with mechanical axis now passing through knee center

If opening wedge technique used, bone graft or bone substitute placed in the gap to promote healing

If fibular osteotomy needed (for severe deformities), small separate incision made and fibula cut

Thorough irrigation of surgical site with antibiotic solution

Meticulous hemostasis (bleeding control) and placement of drain if significant oozing

Layered closure of fascia, subcutaneous tissue, and skin; sterile dressing applied

Long leg cast or knee immobilizer applied if surgeon prefers protected healing (varies by technique)

Both legs treated in single operation if bilateral deformity present (common approach)

Photographs taken for documentation and comparison with pre-operative images

Post-operative radiographs obtained in recovery room to confirm hardware position and alignment

Recovery Timeline

What to expect during your recovery journey

Day 1-3 (Immediate Post-Op)

Hospital Stay and Initial Recovery

Child typically hospitalized 1-3 days depending on procedure complexity and pain control. For guided growth (8-plate), immediate weight-bearing with crutches or walker allowed as tolerated - children usually walk within 24 hours. For osteotomy, protected weight-bearing with crutches/walker for 2-3 weeks until early bone healing. Pain managed with combination of regional blocks, oral medications, and ice application. Physical therapy begins in hospital with gentle range of motion exercises and gait training. Parents educated on wound care, activity restrictions, and pain management at home. Elevation of legs when resting important to minimize swelling. Gentle knee flexion/extension exercises encouraged to prevent stiffness.

Week 1-4 (Early Recovery at Home)

Protected Activities and Wound Healing

First post-operative visit at 10-14 days for wound check and suture removal (if non-absorbable used). For 8-plate patients, rapid return to most activities with common-sense restrictions - avoid contact sports, jumping, running for 4-6 weeks until surgical site fully healed. For osteotomy patients, continued protected weight-bearing with crutches typically for 4-6 weeks total. X-rays at 4 weeks to assess early healing and alignment. Physical therapy continues at home with focus on maintaining range of motion and gradual strengthening. Most children return to school within 1-2 weeks with activity modifications (no PE class, avoiding rough play). Pain typically well-controlled with oral medications; most children off pain meds by week 2-3. Swimming allowed once wounds completely healed (typically 3 weeks).

Week 5-12 (Progressive Activity Increase)

Healing Consolidation and Activity Progression

For 8-plate patients, X-rays every 3-4 months to monitor correction progress - gradual straightening of legs occurs over 6-18 months as child grows. Activity gradually increased with clearance for running, sports participation by 6-8 weeks for most children. For osteotomy patients, X-rays at 6-8 weeks confirm bone healing (bridging callus), allowing progression to full weight-bearing without crutches. Formal physical therapy may continue for osteotomy patients focusing on regaining full strength and range of motion. Return to sports typically cleared at 3-4 months for osteotomy patients once bone fully healed and strength restored. Measurement of intercondylar distance at each visit to quantify correction.

Month 4-12 (Continued Growth and Monitoring)

Long-term Correction Monitoring

For 8-plate patients, continued monitoring every 3-4 months with standing radiographs to measure correction. Full correction typically achieved in 12-18 months (faster in younger children with more growth remaining). Risk of overcorrection monitored - if legs become too straight or start to develop knock-knees, plates removed. For osteotomy patients, bone healing complete by 3-4 months; continued monitoring to ensure maintained correction and symmetric growth. Most children fully released to all activities including competitive sports by 6 months post-surgery. Parents counseled on monitoring for recurrence, though risk is low with proper surgical correction.

Hardware Removal (if applicable)

8-Plate Removal Surgery

For guided growth patients, 8-plates removed once full correction achieved (typically 12-18 months after initial surgery). Plate removal is minor outpatient procedure (20-30 minutes) under general anesthesia. Child weight-bearing immediately and returns to full activities within 1-2 weeks. Some surgeons recommend plate removal, others leave plates permanently if growth plates closing soon. Final standing X-rays obtained to document achieved correction and confirm normal mechanical axis. For osteotomy patients, hardware (plates/screws) may be removed after 18-24 months if causing symptoms, though often left permanently without issues.

Year 2+ (Long-term Follow-up)

Skeletal Maturity and Final Outcome

Annual follow-up through skeletal maturity (age 14-16 for girls, 16-18 for boys) to monitor for recurrence and ensure symmetric growth. Measurement of final limb alignment, leg length equality, and functional outcomes. Parent and patient education on recognition of symptoms that might indicate recurrence or development of opposite deformity (knock-knees). Vast majority of properly corrected children maintain straight legs through adulthood with normal function and gait. Long-term benefit includes prevention of premature knee arthritis that would have occurred with uncorrected bowing. Most children achieve completely normal appearance and function with no long-term activity restrictions. Quality of life outcomes excellent with high patient/parent satisfaction.

Tips for Faster Recovery

Attend all scheduled follow-up appointments for X-rays and measurements - early detection of overcorrection or undercorrection important

For 8-plate patients, understand correction is gradual process taking 12-18 months - patience required as legs slowly straighten

Encourage child to participate in age-appropriate physical therapy exercises to maintain range of motion and strength

No contact sports or high-impact activities for 6-8 weeks until surgical sites fully healed

Watch for signs of infection: increasing redness, warmth, swelling, drainage, or fever - report immediately

For osteotomy patients, strict compliance with weight-bearing restrictions critical for bone healing - use of walker/crutches as directed

Take progress photographs every 1-2 months standing with feet together to document improvement

Vitamin D and calcium supplementation if underlying metabolic cause - follow endocrinologist recommendations

Proper nutrition essential for bone healing and continued growth - ensure adequate protein, calcium, vitamin D intake

If child complains of hardware irritation (prominent plates/screws), discuss with surgeon - removal may be needed

Sun exposure caution for surgical scars during first year - use sunscreen to minimize scar visibility

Monitor for development of opposite deformity (knock-knees) during correction phase - some overcorrection normal

Child may experience temporary growth spurts after surgery - ensure adequate nutrition to support bone healing and growth

Encourage child participation in decision-making and understanding of treatment to improve cooperation with restrictions

Support child emotionally through recovery process - peer education about temporary activity restrictions can help acceptance

Frequently Asked Questions

Common questions about this procedure

Q1.At what age should bowlegs be treated surgically, and will they correct on their own?

Mild bowlegs (physiologic genu varum) is completely normal in infants and toddlers, typically reaching maximum bowing at 12-18 months and then spontaneously correcting by age 18-24 months as the child grows. No treatment is needed for physiologic bowlegs. However, surgical treatment should be considered if: (1) Severe bowing persists beyond age 2-3 years, (2) Bowing is progressively worsening rather than improving, (3) Asymmetric bowing (one leg much more curved than the other), (4) Intercondylar distance (gap between knees with feet together) exceeds 6-8 cm, (5) Underlying pathologic cause identified (Blount disease, rickets, skeletal dysplasia), or (6) Associated with short stature or other skeletal abnormalities. The ideal age for surgery depends on the cause and severity. For pathologic genu varum: Guided growth (8-plate surgery) is most effective between ages 4-13 years when significant growth remains - younger children correct faster (often within 12 months) while older children may take 18-24 months. Corrective osteotomy is preferred for children over age 13 when growth plates are closing, severe rigid deformities, or when guided growth has failed. Early surgical intervention (age 4-6) for infantile Blount disease can prevent permanent growth plate damage and achieve better long-term outcomes. Delaying surgery in pathologic cases increases risk of permanent joint damage and more complex corrective surgery requirements.

Q2.What is the difference between guided growth (8-plate) and corrective osteotomy, and which is better?

Guided growth and corrective osteotomy are two different surgical approaches for correcting bowlegs, each with specific indications. Guided Growth (8-plate/tension band plating): Works by temporarily slowing growth on one side of the growth plate while allowing normal growth on the opposite side, causing gradual correction as the child grows. Advantages include: minimally invasive with small incisions, faster recovery (walking within 24 hours), lower complication rates, no bone cutting required, correction achieved naturally through continued growth. Disadvantages: only effective in growing children (typically under age 13), requires 12-24 months for full correction (patience needed), risk of overcorrection if not monitored closely, requires second surgery to remove plates once corrected. Success rate is 85-90% for appropriate candidates. Corrective Osteotomy: Involves cutting the tibia bone and realigning it to immediately correct the deformity with metal plate fixation. Advantages include: immediate correction achieved (no waiting for gradual improvement), effective at any age including adults, can correct severe rigid deformities, predictable outcomes. Disadvantages: more invasive surgery with larger incisions, longer recovery (6-12 weeks non-weight bearing), higher complication rates (infection, nonunion, hardware problems), requires bone healing time, more post-operative pain. Choice between techniques: Dr. Kumar recommends 8-plate for growing children under 13 with moderate deformities (correctable), while osteotomy is preferred for older adolescents/adults, severe rigid deformities, cases where 8-plate failed, or when immediate correction is desired. Both techniques achieve excellent long-term results (>90% successful correction) when properly indicated.

Q3.What are the risks and complications of bowlegs correction surgery in children?

Bowlegs correction surgery in children is generally very safe with low complication rates, but like all surgeries carries some risks that parents should understand. For Guided Growth (8-plate): Overall complication rate 3-5%. Specific risks include: (1) Overcorrection - legs become too straight or develop knock-knees from excessive correction (5-8% risk), prevented by regular monitoring every 3-4 months and timely plate removal, usually corrects spontaneously after plate removal or may require reverse correction, (2) Undercorrection - insufficient correction achieved (5-10% risk), may require longer time with plates in place or conversion to osteotomy, (3) Implant migration or loosening - screws backing out (2-3%), may cause pain or loss of correction, requires plate removal/revision, (4) Growth plate injury - rare (<1%) risk of permanent growth arrest if screws penetrate growth plate, (5) Infection - very low risk (<1%) with routine antibiotic prophylaxis, and (6) Rebound deformity - bowing recurs after plate removal (3-5%), more common in younger children with significant growth remaining. For Corrective Osteotomy: Higher complication rate 8-12%. Risks include: (1) Delayed union or nonunion - bone fails to heal properly (2-4%), may require bone grafting or revision surgery, (2) Malunion - bone heals in incorrect position (3-5%), may require revision osteotomy, (3) Infection - higher risk than 8-plate (2-3%), may require antibiotics or hardware removal, (4) Neurovascular injury - damage to nerves or blood vessels (rare, <1%), (5) Compartment syndrome - swelling causing muscle/nerve damage (rare, <1%), (6) Hardware irritation - prominent plates/screws causing discomfort (10-15%), often requires hardware removal after healing. General anesthesia risks are very low in healthy children (<0.01% serious complications). At Arthoscenter, Dr. Kumar's complication rates are below national averages due to meticulous surgical technique, appropriate patient selection, and close post-operative monitoring. Most complications when they occur are minor and successfully managed.

Q4.How successful is bowlegs correction surgery and will the deformity come back?

Bowlegs correction surgery has excellent success rates with high patient/parent satisfaction and low recurrence when properly performed. Success Rates by Technique: Guided Growth (8-plate) - 85-92% achieve complete correction of mechanical axis to normal alignment. Time to correction averages 12-18 months (faster in younger children with more growth). Cosmetic improvement is dramatic with legs straightening from bowed to normal appearance. Functional outcomes excellent with normal gait restoration and prevention of future arthritis. At Arthoscenter, Dr. Kumar achieves 89% complete correction rate and 95% patient/family satisfaction. Corrective Osteotomy - 90-95% success rate for achieving planned correction. Immediate alignment improvement at surgery. Bone healing (union) rate >95% by 3-4 months. Long-term maintenance of correction excellent (>90% maintain alignment through skeletal maturity). Recurrence Risk: Overall recurrence of bowing after successful correction is low (5-8%) but varies by underlying cause. Physiologic genu varum corrected surgically - recurrence rate <3%, nearly all maintain straight legs permanently. Blount disease (pathologic cause) - higher recurrence risk especially infantile form (15-25% may develop recurrent bowing or opposite deformity). Risk factors for recurrence: very young age at surgery (<4 years), severe initial deformity, obesity, premature growth plate closure, non-compliance with follow-up monitoring. Most recurrences occur during adolescent growth spurt (ages 11-14) and can be successfully retreated with revision surgery if needed. Prevention of Recurrence: Regular follow-up through skeletal maturity essential - annual visits until growth complete. Weight management important especially for Blount disease patients - obesity increases mechanical stress on bones. Vitamin D supplementation if underlying metabolic cause. Early detection and treatment of recurrence when easier to manage. Long-term Outcomes: Studies show 92-95% of children with surgically corrected bowlegs maintain normal limb alignment into adulthood. Prevention of premature knee arthritis - correcting alignment eliminates abnormal mechanical stress that leads to early cartilage wear. Cosmetic outcomes excellent - most children achieve completely normal leg appearance. No long-term activity restrictions - full participation in sports, physical activities without limitations. Quality of life and patient satisfaction extremely high.

Q5.What is the cost of bowlegs correction surgery and does it vary by technique?

Cost of bowlegs correction surgery at Arthoscenter varies based on surgical technique, complexity, whether one or both legs require treatment, and duration of hospital stay. Guided Growth (8-Plate Surgery): Single leg correction - ₹85,000-1,25,000 including surgeon fees, anesthesia, implants (2 screws + 1 plate per growth plate), operating room, 1-2 day hospital stay, initial follow-up visits. Bilateral correction (both legs) - ₹1,50,000-2,10,000 total. Second stage plate removal surgery (12-18 months later) - ₹40,000-65,000 for bilateral removal including anesthesia and day surgery facility. Total cost for complete treatment (insertion + removal) typically ₹1,90,000-2,75,000. Corrective Osteotomy: Single leg osteotomy - ₹1,35,000-1,95,000 including more extensive implants (plate + 6-8 screws), longer operating time, bone graft if needed, 2-3 day hospital stay. Bilateral osteotomy - ₹2,40,000-3,50,000 total. Fibular osteotomy if needed adds ₹25,000-40,000. Hardware removal (optional, usually 18-24 months later) - ₹65,000-95,000. Total treatment cost ₹2,40,000-4,45,000. Cost typically includes: Pre-operative consultation and examination, all necessary X-rays and imaging studies, surgeon professional fees, anesthesiologist fees, operating room and equipment, implants and surgical materials, hospital room charges, medications during hospital stay, initial post-operative follow-up visits (first 3 months). Additional costs may include: Follow-up X-rays every 3-4 months (₹800-1,200 per visit), physical therapy sessions if needed (₹500-800 per session), special shoes or braces if recommended, treatment of complications if they occur. Insurance Coverage: Most health insurance policies in India cover medically necessary bowlegs correction surgery, especially for pathologic causes (Blount disease, rickets). Coverage typically 60-80% of total costs depending on policy. Cashless facility available for major insurance providers at Arthoscenter. Pre-authorization required - Dr. Kumar's team assists with insurance documentation. Cost Comparison: 8-plate surgery has lower initial cost but requires second surgery for removal, while osteotomy has higher upfront cost but is often single-stage. Overall, both techniques have similar total costs when considering all stages of treatment. Dr. Kumar provides detailed cost estimates during consultation based on child's specific needs and family financial situation. Payment plans available for families needing financial assistance.

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