Leg Straightening Surgery: Procedures, Risks, Recovery, and Outlook

What is the surgery to make your legs straight?

Surgery to correct leg alignment, often performed to address conditions like bowlegs (genu varum) or knock-knees (genu valgum), primarily involves procedures such as osteotomy or, in growing individuals, guided growth, to realign the bones and joints.

Understanding Leg Alignment Issues

Leg alignment issues refer to deviations from the natural straight line of the leg when viewed from the front or back. These conditions can arise from various factors, including genetics, developmental problems, injury, or diseases like osteoarthritis or rickets. While some minor variations are normal, significant malalignment can lead to:

• Pain: Especially in the knees, hips, or ankles.
• Abnormal Wear and Tear: Uneven stress on joint cartilage, accelerating conditions like osteoarthritis.
• Functional Limitations: Difficulty with walking, running, or participation in sports.
• Cosmetic Concerns: Visible bowing or knocking of the legs.

The two most common types of angular deformities are:

• Genu Varum (Bowlegs): Where the knees angle outward, causing the ankles to touch while the knees remain apart. This places increased stress on the inner (medial) compartment of the knee.
• Genu Valgum (Knock-knees): Where the knees angle inward, causing them to touch while the ankles remain apart. This places increased stress on the outer (lateral) compartment of the knee.

Surgical Options for Leg Straightening

The primary surgical procedures used to correct leg alignment are designed to realign the bones, redistribute weight, and alleviate stress on the joints.

Osteotomy

An osteotomy is the most common surgical procedure for correcting angular leg deformities in adults and adolescents with closed growth plates. It involves cutting and reshaping the bone to realign the limb.

• Purpose: To change the mechanical axis of the leg, shifting weight from a damaged or overloaded compartment of the knee to a healthier one.
• Procedure:
  • Bone Cut: A precise cut is made in the tibia (shin bone) or femur (thigh bone), depending on the location of the deformity.
  • Wedge Removal or Addition: A wedge of bone may be removed to shorten the limb and correct an angle (closing wedge osteotomy), or a wedge of bone may be added using a bone graft (opening wedge osteotomy) to lengthen the limb and correct the angle.
  • Fixation: The bone segments are then stabilized with internal fixation devices, such as plates, screws, or rods, to allow for healing in the corrected position.
• Common Types:
  • High Tibial Osteotomy (HTO): Performed on the tibia just below the knee, typically for bowlegs to shift weight to the outer compartment.
  • Distal Femoral Osteotomy (DFO): Performed on the femur just above the knee, typically for knock-knees to shift weight to the inner compartment.

Guided Growth (Epiphysiodesis)

This procedure is specifically for children and adolescents whose growth plates are still open (active). It is a less invasive option that takes advantage of the child's remaining growth.

• Purpose: To slow down or stop growth on one side of a bone, allowing the other side to continue growing and gradually correct the alignment over time.
• Procedure: Small metal plates and screws (often called "tension band plates" or "staples") are temporarily placed across the growth plate on the faster-growing side of the bone. Once the desired correction is achieved, the hardware is removed.

External Fixation and Limb Lengthening/Correction

For more complex deformities, significant leg length discrepancies, or very severe angular deformities, external fixation may be used.

• Purpose: To gradually correct severe deformities or lengthen a limb over an extended period.
• Procedure: An external frame is attached to the bone with pins or wires. After a surgical cut (osteotomy) is made in the bone, the frame is adjusted daily by the patient or family to slowly pull the bone apart, stimulating new bone growth. This method allows for very precise, gradual correction.

Who is a Candidate for Leg Straightening Surgery?

Candidacy for leg straightening surgery is determined by an orthopedic surgeon after a thorough evaluation. Key considerations include:

• Severity of Deformity: The degree of angular deviation and its impact on joint mechanics.
• Symptoms: Presence of pain, instability, or functional limitations that have not responded to conservative treatments (e.g., physical therapy, bracing, medication).
• Age and Growth Potential: Whether growth plates are open or closed influences the type of surgery.
• Overall Health: Ability to undergo surgery and rehabilitation.
• Patient Goals: Understanding of realistic outcomes and commitment to the recovery process.

The Surgical Process: What to Expect

The surgical journey involves several stages:

• Pre-operative Assessment: This includes a comprehensive physical examination, detailed imaging (X-rays, MRI, CT scans) to precisely measure the deformity, and discussions about the surgical plan, potential risks, and expected outcomes.
• The Procedure: Performed under general anesthesia, the surgery typically lasts 1-3 hours, depending on the complexity. The specific steps follow those outlined for osteotomy, guided growth, or external fixation.
• Post-operative Recovery (Immediate): Patients will typically stay in the hospital for a few days for pain management, wound care, and initial mobilization. Weight-bearing restrictions (non-weight-bearing or partial weight-bearing) are common.

Potential Risks and Complications

As with any surgical procedure, leg straightening surgery carries potential risks, including:

• Infection: At the surgical site or involving the bone (osteomyelitis).
• Nerve or Blood Vessel Damage: Although rare, injury to surrounding structures can occur.
• Blood Clots: Deep vein thrombosis (DVT) or pulmonary embolism (PE).
• Non-union or Delayed Union: The bone may not heal properly or may take longer than expected.
• Malunion: The bone heals in an incorrect position, requiring further intervention.
• Hardware Complications: Breakage, loosening, or irritation from plates, screws, or pins.
• Over or Under-correction: The leg may not be perfectly straight, or it may be overcorrected.
• Stiffness: Reduced range of motion in the adjacent joint.

Recovery and Rehabilitation

Recovery is a critical component of successful leg straightening surgery and requires significant commitment.

• Pain Management: Medications will be prescribed to manage post-operative discomfort.
• Weight-Bearing Restrictions: Strict adherence to the surgeon's instructions regarding weight-bearing is crucial for bone healing, often involving crutches or a walker for several weeks or months.
• Physical Therapy: An essential part of rehabilitation. A structured program will focus on:
  • Restoring Range of Motion: Gentle exercises to prevent stiffness.
  • Strengthening Muscles: To support the newly aligned limb.
  • Gait Training: Re-learning how to walk correctly.
  • Balance and Proprioception: Improving stability.
• Follow-up Appointments: Regular visits with the surgeon are necessary to monitor healing progress with X-rays.
• Return to Activity: Full recovery and return to vigorous activities or sports can take anywhere from 6 months to over a year, depending on the procedure and individual healing.

Long-Term Outlook and Considerations

The long-term outlook after successful leg straightening surgery is generally positive, with many patients experiencing:

• Reduced Pain: Alleviation of discomfort caused by malalignment.
• Improved Function: Enhanced ability to walk, run, and participate in daily activities.
• Slower Progression of Arthritis: By redistributing joint load, the surgery can help preserve the knee joint and potentially delay or prevent the need for total knee replacement.
• Improved Cosmesis: A more aesthetically pleasing leg alignment.

It's important to note that while the surgery can significantly improve the mechanical axis of the leg, it does not cure underlying conditions like arthritis. In some cases, hardware may need to be removed in a subsequent procedure. Patients should discuss all long-term expectations and potential future needs with their surgeon.

Conclusion

Surgery to straighten the legs is a significant orthopedic intervention primarily aimed at correcting angular deformities like bowlegs and knock-knees. Procedures such as osteotomy and guided growth are highly effective in realigning the mechanical axis of the limb, reducing pain, improving function, and potentially delaying the progression of joint degeneration. While recovery requires dedication to a rigorous rehabilitation program, the benefits often lead to a substantial improvement in quality of life. Anyone considering such a procedure should consult with an orthopedic surgeon specializing in limb deformity correction to determine the most appropriate course of action.