Home Pediatric OrthopaedicsKnock-Knees Correction (Genu Valgum Treatment) in India

Knock-Knees Correction (Genu Valgum Treatment) in India

Surgical correction of inward-angled knees using guided growth or corrective osteotomy to restore normal leg alignment and prevent long-term knee problems

Book Consultation - ₹999 Call Now

Overview

Dr. Gurudeo Kumar is Bihar's foremost authority on pediatric lower limb deformity correction, having successfully treated over 280 cases of knock-knees (genu valgum) at Arthoscenter Patna with a 98% success rate in achieving normal leg alignment and preventing long-term complications. His comprehensive approach encompasses conservative management for physiologic knock-knees, minimally invasive guided growth techniques for growing children, and precise corrective osteotomies for severe deformities or skeletally mature adolescents. Knock-knees (genu valgum) is a condition where the knees angle inward and touch each other when standing with feet apart, while the ankles remain separated. Mild knock-knees is completely normal in children aged 3-7 years as part of natural developmental lower limb alignment, with most children spontaneously correcting by age 7-8. However, pathologic genu valgum that persists beyond age 8, progressively worsens, is asymmetric (one leg worse than other), or causes functional problems requires medical evaluation and often surgical correction. The condition can result from various causes: physiologic (normal developmental variant that doesn't resolve), metabolic bone disease (rickets causing softened bones), skeletal dysplasias (genetic conditions affecting bone growth), trauma to growth plates near knee, infections affecting growth plates, obesity placing excessive stress on developing knees, or neurologic conditions causing muscle imbalance. Consequences of untreated severe genu valgum include abnormal gait patterns (wide-based walking), difficulty running and playing sports, knee pain from abnormal joint loading (increased lateral compartment pressure), early-onset osteoarthritis (typically developing by age 30-40), patellofemoral pain and patellar instability, and social/cosmetic concerns. Dr. Kumar offers two primary surgical approaches based on skeletal maturity and deformity severity. For children with significant growth remaining (typically ages 8-14 before growth plates close), GUIDED GROWTH using temporary implants (8-plates or tension band plates) placed on inner side of knee gradually corrects alignment over 12-24 months as child grows, then implants removed once alignment normalized. This minimally invasive technique requires small incisions, short surgery (30-45 minutes), and fast recovery with return to activities in 4-6 weeks. For skeletally mature adolescents/adults or very severe deformities, CORRECTIVE OSTEOTOMY involves surgically cutting femur (thighbone) near knee, realigning bone to correct angulation, and securing with plate and screws, providing immediate correction with final alignment achieved at surgery. Arthoscenter's pediatric orthopedic program provides comprehensive care including detailed gait analysis, full-length standing leg X-rays to measure precise deformity angles, assessment of skeletal maturity using bone age studies, and long-term follow-up monitoring growth and development. Most patients treated with guided growth achieve excellent correction (normal alignment within 5° of ideal) with >95% satisfaction and full return to sports and activities. Early intervention prevents progression and reduces risk of developing early arthritis, making timely evaluation crucial for children with persistent knock-knees beyond age 8.

Symptoms & Indications

This surgery may be recommended if you experience:

Knees touching or rubbing together when standing with feet shoulder-width apart - ankles remain separated

Increased space between ankles when standing with knees together (intercondylar distance >3 inches concerning)

Abnormal walking pattern with wide-based gait - legs swing outward to avoid knees hitting each other

Difficulty running smoothly or participating in sports - awkward gait pattern and reduced speed

Knee pain especially on outer (lateral) side of knee - increased pressure on lateral compartment

Frequent tripping or stumbling due to altered gait mechanics and poor foot clearance

Kneecap (patella) deviation or instability - patella tracks laterally causing anterior knee pain

Visible asymmetry - one leg more knock-kneed than other (concerning for unilateral pathology)

Progressive worsening after age 8 - deformity not improving naturally as expected developmentally

Associated short stature or other skeletal abnormalities - may indicate underlying metabolic or genetic condition

Procedure Details

Duration

Guided growth (8-plate insertion): 30-45 minutes per leg, 60-90 minutes for bilateral. Corrective osteotomy: 90-120 minutes for unilateral femoral osteotomy, 150-180 minutes if bilateral. Combined femoral and tibial osteotomy for severe deformities: 120-150 minutes per leg.

Anesthesia

General anesthesia with endotracheal intubation or LMA standard for pediatric patients, ensuring airway protection and complete muscle relaxation. For guided growth in cooperative older children/adolescents, regional anesthesia (spinal or epidural) may be used alone or combined with light sedation. Osteotomy patients typically require general anesthesia given longer operative time and need for complete relaxation. Regional blocks (femoral nerve block or adductor canal block) frequently added for enhanced postoperative pain control, especially for osteotomy procedures.

Preparation for Surgery

Comprehensive pre-operative evaluation essential for optimal knock-knees correction. Initial assessment includes detailed history documenting age of onset, progression over time, family history of skeletal dysplasias or metabolic disorders, and functional limitations. Physical examination assesses intercondylar distance (space between ankles when knees together - normal <3cm in children >7 years), gait analysis observing walking and running patterns, range of motion of hips/knees/ankles, ligamentous laxity, and assessment for associated conditions (flat feet, hip dysplasia). Full-length standing anteroposterior (AP) X-rays of both legs essential - allows measurement of mechanical axis deviation (MAD), lateral distal femoral angle (LDFA - normally 87-89°), medial proximal tibial angle (MPTA - normally 85-90°), and helps localize deformity to femur vs tibia vs both. Bone age X-ray (left hand and wrist) obtained to assess remaining growth potential - critical for deciding between guided growth vs osteotomy. Laboratory tests (vitamin D, calcium, phosphate, alkaline phosphatase) if rickets or metabolic bone disease suspected. For guided growth procedure: patients typically ages 8-14 with at least 1-2 years growth remaining. NPO (nothing by mouth) 6-8 hours before surgery. Pre-operative antibiotics (typically Cefazolin 25mg/kg IV) within 60 minutes of incision. For corrective osteotomy: skeletally mature patients or severe deformities requiring immediate correction. Templating on X-rays to determine precise correction angle and implant positioning.

Surgical Steps

Patient positioned supine on radiolucent operating table allowing fluoroscopy imaging of entire lower extremity

General anesthesia induced with endotracheal intubation or laryngeal mask airway (LMA) for pediatric patients

Pneumatic tourniquet applied to upper thigh (typically inflated to 250-300mmHg) to create bloodless surgical field

Lower extremity prepared and draped from hip to toes maintaining sterile field; both legs prepared for comparison

FOR GUIDED GROWTH WITH 8-PLATES (most common for children with growth remaining):

Fluoroscopy (C-arm) positioned to obtain AP and lateral views of knee joint and growth plates

Two small incisions (2-3cm each) made on medial (inner) side of knee - one over distal femoral physis, one over proximal tibial physis

Incisions placed at junction of anterior and middle thirds of medial knee - away from medial collateral ligament

Subcutaneous tissue dissected bluntly; periosteum visualized and incised to expose bone surface at growth plate level

Guide wire passed perpendicular to growth plate under fluoroscopic guidance - positioned centrally in physis on AP view

Cannulated drill used over guide wire to create holes on either side of growth plate (epiphysis and metaphysis)

Figure-8 tension band plate (8-plate) positioned bridging growth plate with screws on either side of physis

Proximal screw (epiphyseal screw) inserted first, engaging epiphysis but NOT crossing growth plate

Distal screw (metaphyseal screw) inserted engaging metaphysis, creating tension band effect

Plate creates compression on medial side of growth plate, slowing growth medially while lateral side continues growing normally

Process repeated for both distal femur and proximal tibia growth plates (2 plates per leg, 4 plates total if bilateral)

Final fluoroscopy confirming proper plate position, screws not crossing growth plates, and symmetric placement

If bilateral knock-knees: second leg treated in same surgical session using identical technique

FOR CORRECTIVE OSTEOTOMY (skeletally mature patients or severe deformities):

Lateral approach to distal femur most common - incision centered over distal lateral femur (10-15cm)

Skin and subcutaneous tissue divided; iliotibial band identified and split in line with its fibers

Vastus lateralis muscle elevated from lateral intermuscular septum exposing lateral femoral shaft

Periosteum incised and elevated minimally at planned osteotomy site (typically 3-4cm proximal to knee joint line)

Multiple drill holes created across femur at osteotomy site, or oscillating saw used to perform osteotomy

Osteotomy completed leaving small medial cortical hinge intact to aid stability and healing

Distal fragment externally rotated and valgus deformity corrected until mechanical axis normalized (verified by fluoroscopy)

Temporary K-wires inserted to hold correction while plate applied

Locking compression plate (typically pediatric or small fragment 4.5mm LCP) applied to lateral femur spanning osteotomy

Proximal screws inserted first (minimum 3 screws in proximal fragment) followed by distal screws (minimum 3 in distal fragment)

Plate compression applied if bone quality good and transverse osteotomy pattern, or locked screws if comminuted

Final fluoroscopy confirming correction achieved (mechanical axis passing through center of knee), adequate fixation, and no intra-articular screw penetration

CLOSURE (both techniques):

Wounds irrigated copiously with sterile normal saline (2-3 liters for osteotomy, 500ml for guided growth)

Tourniquet deflated and hemostasis achieved with electrocautery

For guided growth: periosteum closed over plate with absorbable sutures; subcutaneous closure with 3-0 absorbable sutures

Skin closed with subcuticular 4-0 absorbable sutures or surgical glue (Dermabond) for cosmetic closure in children

Sterile dressings applied; knee immobilizer or cylinder cast applied for comfort (especially osteotomy patients)

Post-operative X-rays obtained in recovery room confirming hardware position and initial alignment

For guided growth: weight-bearing as tolerated immediately with crutches for comfort; knee immobilizer for 1-2 weeks

For osteotomy: toe-touch weight-bearing only for 6 weeks with crutches; progressive weight-bearing as healing progresses

Recovery Timeline

What to expect during your recovery journey

Week 1-2: Immediate Post-Operative (Guided Growth)

Wound Healing and Early Mobilization

Most guided growth patients discharged same day or after overnight observation. Knee immobilizer worn for comfort first 1-2 weeks, removed for sleeping and gentle range of motion exercises. Weight-bearing as tolerated immediately with crutches for balance and confidence - most children bearing full weight within 3-5 days. Pain typically mild to moderate, managed with acetaminophen or ibuprofen; opioids rarely needed. Ice application 15-20 minutes every 2-3 hours first 48 hours reduces swelling. Small adhesive bandages over incisions; shower permitted after 3-4 days protecting incisions with waterproof covering. No restrictions on sitting, lying down, or gentle walking. Follow-up at 10-14 days for wound check and suture removal (if non-absorbable sutures used). X-rays obtained confirming hardware position unchanged. Parents counseled that correction gradual process occurring over 12-24 months as child grows, not immediate.

Week 2-6: Return to Activities (Guided Growth)

Progressive Activity Resumption

Knee immobilizer discontinued at 2 weeks once initial discomfort resolved. Return to school typically 1-2 weeks post-surgery with no physical education restrictions beyond avoiding contact sports. Walking normalized; crutches discontinued when child comfortable (usually 2-3 weeks). Light recreational activities permitted (swimming, cycling, walking) at 3-4 weeks. Running and sports involving cutting/pivoting (soccer, basketball) typically resumed at 4-6 weeks once surgical sites healed and no residual pain. No permanent activity restrictions - 8-plates designed to remain in place during all normal activities. Parents educated about expected timeline: first 6 months may see minimal visible change, significant correction typically becomes apparent 9-18 months post-surgery as cumulative effect of growth modulation occurs. Follow-up X-rays every 3-4 months monitoring correction progress and ensuring plates functioning properly (no migration, breakage, or premature physeal closure).

Month 3-12: Correction Phase (Guided Growth)

Ongoing Growth Modulation and Monitoring

Child continues normal activities including sports with plates in place - no restrictions. Gradual correction of alignment becomes visually apparent typically around 6-9 months post-surgery. Serial full-length standing leg X-rays every 3-4 months documenting progressive improvement in mechanical axis and knee angles. Average correction rate approximately 0.5-1° per month, so moderate deformity (10° valgus) may take 12-18 months to fully correct. Parents counseled to watch for overcorrection (legs starting to bow outward) - indicates plates should be removed soon. Some children experience accelerated correction in first year after surgery as growth velocity peaks. Physical activities unlimited - children can participate fully in sports, gym class, and recreational activities. Plates tolerated well; complications rare but include plate migration (<2%), screw loosening (<1%), or premature physeal closure (very rare <0.5% - more common if plates left too long after correction achieved).

Month 12-24: Achieving Final Alignment (Guided Growth)

Completion of Correction and Plate Removal

Most patients achieve target alignment (neutral or slight valgus 5-7°) within 12-24 months depending on initial deformity severity and remaining growth. Once full-length X-rays show desired alignment achieved, plates scheduled for removal to prevent overcorrection into bowleg deformity. Plate removal simple outpatient procedure (20-30 minutes) under general anesthesia; smaller incisions than original surgery since hardware easily accessible. Recovery after plate removal rapid - most children resume activities within 2-3 weeks. After plate removal, growth plates resume symmetric growth maintaining corrected alignment. Final follow-up X-rays 6-12 months after plate removal confirming alignment maintained and no rebound deformity. Long-term outcomes excellent with >95% patients achieving and maintaining normal leg alignment, full return to sports and activities, and high satisfaction. Risk of recurrence very low (<3%) once skeletal maturity reached, though patients with underlying metabolic conditions or skeletal dysplasias may experience gradual recurrence requiring repeat intervention.

Week 1-12: Recovery After Corrective Osteotomy

Bone Healing and Progressive Weight-Bearing

Osteotomy patients hospitalized 2-4 days for pain management and physical therapy training. Strict non-weight-bearing or toe-touch weight-bearing first 6 weeks with crutches or walker to protect healing osteotomy. Knee immobilizer or hinged knee brace worn continuously first 2-3 weeks, then during walking for additional 3-4 weeks. Pain significant first week, managed with IV pain medications transitioning to oral narcotics by discharge, then weaned to NSAIDs by 2-3 weeks. Physical therapy started in hospital focusing on gentle range of motion exercises, quad sets, and crutch training. Follow-up X-rays at 2, 6, and 12 weeks monitoring callus formation and bone healing. Callus typically visible by 4-6 weeks indicating healing progressing. Progressive weight-bearing protocol: toe-touch weeks 0-6, partial weight-bearing (50%) weeks 6-8, weight-bearing as tolerated weeks 8-10, full weight-bearing by 10-12 weeks if X-rays show adequate healing. Formal physical therapy 2-3 times weekly focusing on regaining knee range of motion and quadriceps strength. Return to school with crutches typically 2-3 weeks; full academic activities resumed once comfortable sitting extended periods.

Tips for Faster Recovery

For guided growth: plates remain in place during all activities - no restrictions on running, jumping, or sports once healed (4-6 weeks)

Correction is GRADUAL process taking 12-24 months - do not expect immediate visible change after surgery

Regular follow-up X-rays critical (every 3-4 months) to monitor correction and prevent overcorrection

Watch for signs of overcorrection (legs starting to bow outward) - indicates plates should be removed promptly

After plate removal, correction maintained permanently - growth plates resume normal symmetric growth

For osteotomy: strict adherence to weight-bearing restrictions ESSENTIAL - early weight-bearing risks hardware failure or loss of correction

Maintain excellent nutrition for bone healing: adequate protein, calcium (1200-1500mg daily), vitamin D (800-1000 IU daily)

Physical therapy compliance critical for osteotomy patients - prevents stiffness and ensures full range of motion recovery

Ice and elevation first week reduces swelling and pain significantly

Watch for infection signs: increasing redness, warmth, drainage, fever - requires immediate medical attention

Swimming excellent exercise once incisions healed (3-4 weeks) - builds strength without impact stress

For bilateral procedures: children adapt remarkably well - most walking without aids within 2-3 weeks

School accommodations may include elevator access, extra time between classes, modified PE participation initially

Psychological support important - children may feel self-conscious about leg appearance, crutches, or activity modifications

Long-term prognosis excellent - >95% patients achieve normal alignment, return to all activities, and prevent future arthritis

Frequently Asked Questions

Common questions about this procedure

Q1.Is knock-knees normal in children, and when does it require treatment?

Knock-knees (genu valgum) is COMPLETELY NORMAL developmental stage in young children and does NOT require treatment in most cases. Understanding normal lower limb alignment development critical: Newborns have bowlegs (genu varum) due to position in womb. Ages 0-18 months: bowlegs gradually straighten. Ages 18 months-3 years: legs become straight (neutral alignment). Ages 3-7 years: physiologic knock-knees develops - knees angle inward while ankles separate. This NORMAL developmental knock-knee typically peaks around age 3-4 (intercondylar distance 5-8cm normal) then gradually corrects, with most children achieving adult alignment (slight knock-knee 5-7° valgus) by age 7-8. TREATMENT INDICATED only if: (1) Knock-knees persists or worsens beyond age 8, (2) Severe deformity (intercondylar distance >10cm or mechanical axis deviation >10mm), (3) Asymmetric - one leg significantly more knock-kneed than other (suggests unilateral growth disturbance requiring evaluation), (4) Associated with pain, difficulty walking, or functional limitations, (5) Progressive worsening rather than improving, or (6) Underlying condition identified (rickets, skeletal dysplasia, growth plate injury). For children under age 8 with physiologic knock-knees, OBSERVATION only - reassess every 6-12 months with X-rays if severe or concerning features present. Parents counseled that vast majority of childhood knock-knees resolves spontaneously without any treatment. However, pathologic knock-knees that persists beyond normal developmental window requires intervention to prevent long-term complications including abnormal gait, knee pain, and early arthritis (typically developing by age 30-40 if severe untreated knock-knees). Dr. Kumar's approach: thorough evaluation distinguishing physiologic (normal, will resolve) from pathologic (requires treatment) knock-knees, avoiding unnecessary surgery for normal developmental variants while ensuring timely intervention for true deformities.

Q2.What is guided growth with 8-plates, and how does it work to correct knock-knees?

Guided growth using tension band plates (8-plates or two-hole plates) is modern, minimally invasive technique for correcting knock-knees in children with remaining growth. Based on HUETER-VOLKMANN LAW: compression slows bone growth while tension accelerates growth. TECHNIQUE: Small metal plates (shaped like figure-8) placed on inner (medial) side of knee bridging growth plate (physis) with one screw in bone above growth plate (epiphysis) and one screw below (metaphysis). Plate creates compression force across medial side of growth plate, slowing growth on that side, while lateral (outer) side of knee continues growing normally at full speed. This differential growth gradually corrects knock-knee deformity over 12-24 months. ADVANTAGES over traditional osteotomy: (1) Minimally invasive - two small 2-3cm incisions per leg vs large 10-15cm osteotomy incision, (2) Short surgery time (30-45 minutes per leg) vs 2+ hours for osteotomy, (3) Rapid recovery - full weight-bearing immediately, return to sports 4-6 weeks vs 3-4 months for osteotomy, (4) No bone cutting - avoids risks of osteotomy including nonunion, malunion, neurovascular injury, (5) Adjustable - if overcorrection occurs, simply remove plates; osteotomy correction permanent and difficult to revise, (6) Lower complication rate (<3% vs 10-15% for osteotomy), and (7) Lower cost (₹1-1.5L vs ₹2.5-3.5L for osteotomy). REQUIREMENTS for guided growth: Child must have adequate growth remaining (typically ages 8-14 before growth plates close). Bone age X-ray determines eligibility - need minimum 1-2 years growth remaining for technique to work. CORRECTION TIMELINE: First 3-6 months minimal visible change, significant improvement apparent 9-18 months, most patients achieve target alignment 12-24 months. Average correction rate 0.5-1° per month (faster in younger children with more growth remaining). PLATE REMOVAL: Once desired alignment achieved, plates removed in simple outpatient procedure; growth plates then resume symmetric growth maintaining correction. LIMITATIONS: Not suitable for skeletally mature patients (growth plates closed), very severe deformities (>25° correction needed - may take too long), or when immediate correction needed. Overall, guided growth revolutionized pediatric knock-knee treatment - replaced osteotomy as first-line surgical treatment for most cases due to superior safety, faster recovery, and excellent outcomes with >95% achieving target alignment.

Q3.What are the risks and complications of knock-knee correction surgery?

Complication rates vary significantly between guided growth (8-plates) and corrective osteotomy. FOR GUIDED GROWTH: Overall complication rate low (3-5%) with most complications minor. INFECTION (1-2%): superficial wound infection typically resolves with oral antibiotics; deep infection requiring plate removal very rare (<0.5%). PLATE MIGRATION (1-2%): plate shifts position losing effectiveness; requires repositioning if caught early or may need osteotomy if correction not achieved before skeletal maturity. SCREW LOOSENING (<1%): screw backs out of bone; usually asymptomatic but may require removal/replacement if painful. OVERCORRECTION (2-3%): legs correct beyond neutral into bowleg deformity; prevented by careful monitoring with X-rays every 3-4 months and timely plate removal once target reached; if occurs, can be corrected by placing plates on opposite (lateral) side or may spontaneously improve with continued growth after plate removal. PREMATURE PHYSEAL CLOSURE (<0.5%): growth plate closes early stopping all growth; very rare but devastating; more common if plates left in place too long after correction achieved or screws inadvertently cross growth plate during insertion. INCOMPLETE CORRECTION (3-5%): deformity not fully corrected before growth plates close naturally; more common if surgery delayed until late adolescence with minimal growth remaining; may require osteotomy for final correction. REBOUND DEFORMITY (2-3%): knock-knees recurs after plate removal; more common in patients with underlying metabolic conditions (rickets) or skeletal dysplasias; may require repeat plating or eventual osteotomy. FOR OSTEOTOMY: Higher complication rate (10-15%) typical of more invasive surgery. INFECTION (3-5%): higher due to larger incisions and more extensive soft tissue dissection; deep infection may require hardware removal and prolonged IV antibiotics. NERVE INJURY (1-2%): peroneal nerve most at risk especially with proximal tibial osteotomy; can cause foot drop if damaged. VASCULAR INJURY (<1%): rare but serious; popliteal artery at risk especially with tibial osteotomy. NONUNION (1-2%): bone fails to heal; more common in smokers, malnourished patients; requires revision surgery with bone grafting. MALUNION (2-3%): bone heals in incorrect position; under-correction or overcorrection requiring revision. HARDWARE COMPLICATIONS (5-10%): prominent painful hardware requiring removal, screw breakage, plate irritation. STIFFNESS (5-10%): loss of knee range of motion especially if prolonged immobilization; prevented with early range of motion exercises. COMPARTMENT SYNDROME (<1%): emergency requiring urgent fasciotomy. Despite these risks, both techniques safe when performed by experienced pediatric orthopedic surgeon with appropriate patient selection. Guided growth preferred when possible due to lower risk profile; osteotomy reserved for skeletally mature patients or very severe deformities where guided growth not feasible.

Q4.How long does it take to see results after knock-knee surgery, and what is the success rate?

Timeline and success rates differ significantly between guided growth and corrective osteotomy. FOR GUIDED GROWTH: Results NOT immediate - correction gradual process occurring as child grows over 12-24 months. EXPECTED TIMELINE: Month 0-3 (minimal visible change - early compression effect starting but not yet apparent; X-rays may show slight improvement in angles but not obvious to naked eye; parents counseled to be patient), Month 3-6 (subtle changes becoming noticeable - family/friends may comment legs looking straighter; X-rays showing measurable improvement 3-5° correction), Month 6-12 (significant visible correction - obvious improvement in leg alignment; most patients achieve 50-75% of total correction during this period), Month 12-18 (approaching target alignment - most moderate deformities fully corrected; severe deformities may need additional 6-12 months), Month 18-24 (final correction achieved - plates removed once target reached). CORRECTION RATE varies by age: Younger children (ages 8-10) with more growth remaining correct faster (0.75-1° per month), older children (ages 11-13) correct more slowly (0.5-0.75° per month), adolescents approaching skeletal maturity (ages 13-14) slowest (0.25-0.5° per month). TYPICAL CORRECTIONS: Mild deformity (5-10° valgus) corrects in 12-18 months, moderate (10-15°) takes 18-24 months, severe (15-20°) may require 24-30 months. SUCCESS RATE guided growth: EXCELLENT with >95% patients achieving target alignment (within 5° of neutral) when adequate growth remaining and proper follow-up maintained. Failure rate low (3-5%) typically due to inadequate growth remaining, poor compliance with follow-up allowing overcorrection, or premature physeal closure. Patient satisfaction very high (>95%) given minimal invasiveness, rapid recovery, and excellent cosmetic/functional results. FOR CORRECTIVE OSTEOTOMY: Results IMMEDIATE - final alignment achieved at surgery, visible as soon as post-op X-rays obtained. However, full functional recovery takes longer. EXPECTED TIMELINE: Week 0-6 (non-weight-bearing healing phase - legs straight but patient on crutches), Week 6-12 (progressive weight-bearing - continuing to heal, starting to walk), Month 3-6 (return to activities - bone healed, returning to sports and full function), Month 6-12 (full recovery - maximal strength and motion regained). SUCCESS RATE osteotomy: Very high (>92%) for achieving target mechanical axis, though complications more common than guided growth. Long-term satisfaction excellent (>90%) despite more difficult recovery, as immediate correction appealing to some patients and families. REBOUND/RECURRENCE: Very low (<2%) for both techniques once skeletal maturity reached, though patients with underlying metabolic or genetic conditions higher risk. PREVENTING LONG-TERM ARTHRITIS: Both techniques highly successful at normalizing knee biomechanics and preventing premature arthritis - studies show <5% develop early knee arthritis after successful correction vs >60% with untreated severe knock-knees. Key to success: appropriate patient selection (guided growth for growing children, osteotomy for skeletally mature), precise surgical technique, and diligent follow-up monitoring correction and preventing overcorrection.

Q5.What is the cost of knock-knee correction surgery, and is it covered by insurance?

Cost varies significantly based on technique (guided growth vs osteotomy), unilateral vs bilateral treatment, and hospital facility. AT ARTHOSCENTER PATNA typical costs: GUIDED GROWTH (8-PLATE INSERTION): Unilateral (one leg): ₹1,00,000-₹1,50,000 covering surgeon fees, anesthesia, implants (2 eight-plates + 4 screws), operative facility, 1-day hospitalization, post-operative care including multiple follow-up visits with X-rays over 12-24 months monitoring correction. Bilateral (both legs): ₹1,80,000-₹2,50,000 for treating both legs simultaneously (more cost-effective than two separate surgeries). PLATE REMOVAL (after correction achieved): ₹40,000-₹60,000 per leg as outpatient procedure; some insurance policies cover removal, others consider it separate procedure. Total cost for complete guided growth treatment including insertion and removal: ₹1,40,000-₹2,10,000 unilateral, ₹2,20,000-₹3,10,000 bilateral. CORRECTIVE OSTEOTOMY: Unilateral femoral osteotomy: ₹2,50,000-₹3,50,000 covering surgeon fees, anesthesia, implants (locking plate + 8-12 screws), longer operative time, 3-4 day hospitalization, intensive physical therapy, and post-operative care. Bilateral osteotomy: ₹4,50,000-₹6,00,000 if both legs treated (typically staged 3-6 months apart rather than simultaneously). Combined femoral and tibial osteotomy for very severe deformities: ₹3,50,000-₹5,00,000 per leg. ADDITIONAL COSTS (both techniques): Pre-operative evaluation including full-length leg X-rays, bone age study: ₹3,000-₹5,000. Physical therapy (primarily for osteotomy): ₹500-₹1,000 per session, typically 15-25 sessions = ₹7,500-₹25,000 total. Post-operative medications and supplies: ₹3,000-₹8,000. Follow-up X-rays every 3-4 months for guided growth (12-24 months): ₹1,500-₹2,500 per visit × 4-6 visits = ₹6,000-₹15,000. INSURANCE COVERAGE: Knock-knee correction surgery considered MEDICALLY NECESSARY (not cosmetic) when meets criteria: age >8 years with persistent deformity, intercondylar distance >8cm, mechanical axis deviation >10mm, progressive worsening, functional limitations, or pain. Most Indian health insurance policies COVER pediatric orthopedic deformity correction with typical coverage 70-90% of total costs after deductible. Cashless facility available at Arthoscenter for major insurers (Star Health, ICICI Lombard, HDFC Ergo, Care Health, Religare, etc.). Patient co-pay typically 10-30% depending on policy. PRE-AUTHORIZATION REQUIRED - detailed documentation submitted including clinical photos, X-rays, and medical necessity justification. GOVERNMENT SCHEMES: PMJAY (Ayushman Bharat) covers knock-knee correction surgery for eligible families (income <₹5 lakhs/year) with minimal out-of-pocket cost (₹0-₹10,000). State government employee insurance schemes typically provide coverage. ESI (Employee State Insurance) covers for eligible workers. PAYMENT OPTIONS: Cash payment discounts (5-10% off), interest-free EMI plans (6-12 months), partnered with healthcare financing companies (Bajaj Finserv, HDFC Credila) offering 0-12% interest loans. COST-EFFECTIVENESS: Despite upfront costs, treating knock-knees in childhood highly cost-effective long-term - prevents premature knee arthritis requiring knee replacement (₹3-5 lakhs) in 30s-40s, avoids decades of pain medications and physical therapy, maintains employment/productivity, and dramatically improves quality of life. Dr. Kumar works with families to ensure all children needing treatment can access care regardless of financial constraints.

Considering This Surgery?

Book an online video consultation with Dr. Gurudeo Kumar for just ₹999 and get all your questions answered

Book Consultation Now +91 72580 65424

Arthoscenter