CENTER OF ANTHROPOMETRIC
(ORTHOPEDIC) COSMETOLOGY AND CORRECTION

expert in legs correction
& lengthening since 1992!

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Operative correction
of bowed legs and knock knees
Correct your
O-legs or X-legs

What do we call ideal legs?

Of course, each of us has their own idea of legs beauty, though is it common to think that ideal legs must have tree points of connection: knee joints, soft tissues of shins and ankles.

IDEAL LEGS

True “O” -shaped  deformity (genu varus)

- this is a kind of deformity when legs have the shape of “O” letter and  the knees cannot touch  each other.  

True “X”-shaped deformity, knock knees (genu valgus) 

- this is a deformity when the legs have the shape of X letter and ankles and feet cannot touch each other. 

With the true deformity everything is clear, it is a deformity of the bones! But there is one more kind of deformity, a so-called “False legs deformity” - this is a peculiar structure of lower limbs and distribution of the soft tissues in such a way that visually the legs look bowed, though actually there is no deformity. In a number of false deformity cases the gap between the knees may be up to 1.5-2 cm though a correct anatomical axis is preserved.       

In the first two cases (True "О"-shaped deformity and True  "Х"-shaped deformity ) surgical lintervention into the bones is necessary – legs correction is possible with osteotomy.

In the case of false deformity when the bones are straight  and only soft tissues are distributed   unaesthetically, we can advise to improve the situation in the gym. There are special exercises that help give  shin muscles a nice shape.
If you fail to shape your legs with exercises, plastic surgery can help either with implants or lipofilling. 



Beauty or Health???

             
Everything is clear with aesthetics – bow legs (even if it is a false deformity) just do not look nice. But we all, men and women, strive for harmony not only of our inner world but also of out appearance.

Remember! Having bow legs is not only unattractive but also hazardous for your health.

Let us consider this issue in details:

If you have O or X deformity, you should think about a surgery.
Deformation of the shins is not only a cosmetic effect, in this kind of pathology the load on the hip joints at the knee joints is uneven. With time it results in osteoarthrosis  or gonarthrosis ( cartlilage wear). Shins deformity also provokes development of flat feet.

Only a professional is able to determine the degree of deformity after X-ray examination. The basis is the so-called mechanical axis, an imaginary line connecting the center of the femoral head with the middle of the ankle joint.

Normally the axis is deviated from the middle of the knee joint to the center by 1 cm. If the axis is deviated outward, true X-shape deformity occur. The cause of it may be angulation of the femur or tibia.   

With age legs shape changes, that is why do not hurry with the surgery in childhood without  the doctor’s advice. At the same time, deformity may result in serious  conditions of the knee joints. For this reason it is advisable to operate adults before the first clinical signs of  the secondary diseases of the joints appear.

Even a slight deviation may have negative effects and may provoke development of the flat foot and problems with the spine. Though most often bow legs cause problems with the knee joints because the body weight is spread unevenly along the joint and the pressure  is exerted only on the outer or inner part.


As a result of a long and wrong impact on the knee joints, their tissues wear out. If the  condition is not corrected,  with time legs deformity lead to serious diseases, such as arthrosis and arthritis. Neglected cases may have irreversible effect including complete loss of the joint performance.

To improve the biomechanical axis of the low extremities, it is necessary to perform an artificial fracture of the bone and then fix the bone fragments with Ilizarov frames. Unfortunately it is hardly possible to correct «О" - or "X" – shapes legs with any other methods, because it is necessary to correct the legs axis in such a way, that the body could obtain a correct natural support. 

 

Now let us consider the main methods of bow legs correction
In this part we will speak about correction of only TRUE deformity as in FALSE deformity methods of contour plastics and lipofilling are more appropriate. 

So, correction of bow legs is possible by means of the operation  on the bones – osteotomy. The main point of the operation is that the bone is partially or completely cut and united in a correct position.  Correction can be  done either as a single-step or  step-by-step and the bones are held in the correct position with the help of the frames, nails, plates, etc. 
Different clinics use different method.  

Main methods of osteotomy:

1-incomplete osteotomy; 
2-complete osteotomy; 
3-medializing osteotomy (with a shift of the bone fragment inward).
4-complete cuneiform osteotomy or fragmental osteotomy (performed  for  the tibia lengthening) .

At  Da Vinci clinic the method of incomplete osteotomy is used. 
The main advantages of this method are:
-low traumatism, 
-short period of treatment, 
-planning of the desired outcome,
- accuracy and symmetry of correction.

Fixation of the bones is done with the external fixation apparatus:

This is how the apparatus looks like on the leg: 


Let us consider the method of INCOMPLETE OSTEOTOMY used in our clinic: 


This method is suitable for people with a true bow-leggedness and aesthetical distribution of soft tissues on the shin.
if you have a true legs deformity and the inner muscles of the shin are well developed, the method of incomplete osteotomy is for you. In any case we can advise you to make  a modeling first and evaluate the possible result  from the aesthetic point of view. 

The surgery is performed first on one leg and then on the other one. In this method, a special orthopedic apparatus is put below the knee: firstly,  thin but strong pin made from special and safe medical steel are   drawn through the bone in the upper and lower part of the shin.  

Then the pins are firmly fixed in the apparatus rings, thus forming a strong apparatus –bone system.  Finally, osteotomy (none cutting) is performed.  Osteotomy of corticotomy type  is done with a special orthopedic chisel (corticotomy is a partial dissection of the strongest bone elements with the least  injury to the surrounding tissues). In the end,  cosmetic sutures are put.  
In the process of correction with the external fixation apparatus the external cortical plate flexes but does not break. This principle of this surgery is shown schematically:    

1 – Bone shape before the operation; 
2 – Incomplete osteotomy with the angular correction (the external cortical plate if deformed but not broken); 
3 – Callus (regenerate) fills the cuneiform defect at the osteotomy site keeping  the correct bone shape; 
4 - Long after the operation, the osteotomy are completely transforms taking the shape of the surrounding bone.

 

 


For the patients to understand what other methods of correction exist, I would like to tell about the most popular ones. 

As I wrote earlier, at our clinic the method of incomplete osteotomy is used. 
Besides, there is also the method complete osteotomy which is not used at out clinic for the bone correction.  
What is this method about?  
During the surgery, the bone is completely dissected. It affects the period of  union making it longer but at the same time it gives an additional opportunity to shift the fragment s relative to each other (to perform medialization and rotation).  

What is rotation? 
Rotation: In complete fracture there is a possibility to eliminate rotation of the knee joints turning the bone fragments around their axis in a desired direction. Rotation is used in the patients whose knee joints were initially rotated either in- or outward.   

What is medialization? 
This method is often used to improve the legs shape with unattractive distribution of soft tissues over the shin (false bow-leggedness).  
Shifting a lower fragment (medially – closer to the center of the body) allows to shift  the soft tissues in the upper part of the shin inward if they are not clearly expressed.  

So a complete osteotomy with an inward shift of the peripheral fragment looks like (with medialization) :  

1 – Initial bone shape with a deformity; 
2 -  Cutting the bone and the shift of the fragment inward that results in the bone straightening;   
3 – The callus connects both fragments smoothing the form ;   
4 – A few years later, the bone fully restores its initial structure; 

There are a lot of discussions on additional manipulations during correction (rotation and medialization ) though there is no uniform opinion on the subject among the surgeons.

These are patients themselves who should decide which position is better. 
As for our clinic’s position concerning medialization, we are against this manipulation and think that it is harmful for health. For this reason we do not use it without real indications.

Here is a short passage from an article about correction. It was written by Alexander S. Barinov and published in a medical journal:


"As for the aesthetic aspect of varus and valgus deformities correction, one should mention that aesthetics of correction and patient’s satisfaction with a final result who are primarily interested in aesthetics, depends how  the soft tissues are distributed around the knee joints and on the inner and outer sides of the shin. As a rule, patients with a well developed muscles of the inner group  have a better result from the viewpoint of aesthetics. After correction when the feet are put together the knee joints and inner parts of the shins also connect. If the shin muscles are poorly developed, after correction only the knee joints touch each other and there is still a small gap between the inner parts of the shins. Most patients are satisfied with such correction.  
In some cases when the soft tissues are poorly distributed, patients cannot be fully satisfied. An example of such unfavourable soft tissues distribution is hypertrophy (poor development)  of the inner group of muscles in combination with hypertrophy ( excessive development) of the outer group of muscles, a high position of the hypertrophied head of the fibula, hypertrophy of the hypoderm on the inner surface of the knee joints and thighs. If the patients are not satisfied with correction, they are advised to increase the inner group of muscles with regular exercises (if exercised regularly, the result may be seen in half a year) or additional aesthetic correction by plastic surgery  ( liposuction of excessive fat in the area of the knee joints, thighs and shins, implants modeling the inner outline of the shins, lipofilling). 
We always do a computer modeling prior to the surgery to evaluate a possible result of correction. In this case, the patient can see how their legs will look like after correction and evaluate the aesthetic aspect before they decide about the surgery. The operation is performed only if the patient is satisfied with the correction.  
Some experts in their strive for the aesthetic result try to correct soft tissues  by shifting distal bone fragments inward. Such planned shift of the bone fragments is called medialization. In doing so  coaxiality of the bone fragments is upset that slows down union of the bones. Besides, medialization provokes the inner shift of the  mechanical axis of the lower extremity. This leads to the overload of the inner condyles of the knee joint.  In this case the principle “Do not harm” is violated because the inner part of the joint is already overloaded and the surgery may give additional overload on the joint. Recently, the authors of this method note aesthetical inexpediency of significant medialization without considering biomechanical aspects of such correction. We think that a biomechanical factor is dominating as legs function is to hold the body and move it in space and these functions cannot be sacrificed for aesthetic changes of dubious value”    

Certainly, some patients prefer visually attractive picture of legs than their health and they agree to medialization in spite of the risk. You have the right to choose the doctor and the clinic but you should weigh 100 times all pros and contras. 


We would advise not to create a muscle relief shifting the bone if the muscles are unfavourably distributed but use safer methods such as implants and lipofilling. 

To familiarize with the opinion of other doctors, we could offer to read the article on medialization in the journal called  Вопросы реконструктивной и пластической хирургии. 
Its main points:
"In other words, medialization is an attempt to change the orthopedic norm in favor of the attractive appearance. We would like to believe that no one of orthopedists corrected shins appearance  applying corrective osteotomy with medialization for  the so-called false bow-leggedness. It is a plastic surgeon’s job” 

"Considering technical complexity and contradictory results of  significant shifting  the distal fragment of the tibia (up to 15 mm and more), this manipulation can hardly be seen as suitable. 
With more experience in plastic surgeries to correct the soft tissues outline,  combined methods of operative orthopedics plastic surgery seem to be  promising and appropriate” 

       

Now let us talk about additional methods:  or how we can correct the False bow-leggedness

At Da Vinci clinic it is possible to correct bow legs not only by osteotomy but also with implants.  
This method is called cruroplasty.  

Cruroplasty can be used  as a separate method to correct bow legs (if you have only false bow legs) and alongside with osteotomy ( if you have true bow legs and poorly developed shin muscles) . 

Shin increase (cruroplasty, shin plastiy)  is a surgery aimed at the correction of shin size and shape. The surgery is performed by endoprosthesis  of special silicone implants. The surgery is not complicated technically.  
To achieve the aesthetic result,  a number of rehabilitation procedures is important. All doctor’s recommendations  and orders must be strictly followed.  The result can be predictable only under the condition that the person follows the regimen prescribed by the doctor.  

The  healing process takes a year, for this reason the final evaluation  can be done  only a year after the operation. During this time a capsule and a scar are formed. 

I told about this method  in (Shin increase (cruroplasty, shin plasty) 

   

Lipofilling   is one more method to correct bow legs at Da Vinci clinic.

  Lipofilling is an alternative to cruroplasty. It is also used in case of false bow legs.  
Lipofilling (lipografting, liposculpture)  is  a face and body correction  by transplantation of  one’s own adipose tissues from one area to another. Lipofilling is used to correct size and shape. 

The operation is performed under a local anesthesia  in a few stages. Firstly, the adipose tissue is taken in the area the person suggests (abdomen, hips, knees, etc.) Then the fat settles, is centrifuged and the fraction of one’s own fat is injected into the problem area.

Three-six months later (if indicated) an additional lipofilling procedure is performed if there are direct indications for it (gradual correction, a larger size is required, most part of the fat has been resolved, etc.)  

Summary data show that 25-30% of the transplanted fat resolves. 
Lipofilling of the extremities requires correction procedures as the vascularization process  -  blood vessels invasion  -  is worse in these areas  than in the facial zones. Fat survives slower. In this case the patient can evaluate the final result  only 3-6 months after the operation. Sometimes  3-4 corrections are required  (additional fat injection) with the time gap of 3-6 months.  

To achieve the aesthetic result, it is important to carry out a number of procedures in the postoperative (rehabilitation) period.  It is also important to follow all doctor’s recommendations.  

I told more detailed about this method in   ” Lipofilling for bow legs correction” 

     

Conditions of the treatment

Our patients start walking independently with crutches the next day after the operation. The patients are active, they can serve themselves, for this reason there is no need to have their relatives or accompanying persons at hand. Albeit, we don’t restrict any contact, and relatives and guests can spend their time with patients all day long. 

Our patients’ should not be less than 16 and no older than 60 years of age. During the treatment, patients should either stay in the hospital, or rent an apartment or stay at a hotel under constant supervision of our doctors and closely follow all their instructions. It’s only in this case that we can guarantee success.  

By the end of treatment, the patients are able to walk without crutches. The patients are able to resume their daily routine and way of life 2-3 weeks after leaving the hospital. 

The cost of the complex of sevices for legs form correction including all expences (operation, anaesthesia, accommodation in postoperative period, doctors supervision, computer modelling, changing of bandages, removing of external fixators) is 7500 euros in Volgograd clinic of the Center.

The treatmens is also available in our partner clinic in Czech Republic. Please request information by e-mail: info@rucosm.com

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