Bow-legs correction

Bow-legs are known medically as 'varus deformity'. In this case presentation the patient himself takes you through his osteotomy experience after he had struggled for some years with bilateral varus deformity.

This gentleman was always very active, especially in martial arts, and by the age of 26 he had earned a Black Belt in Tae kwon do. There was never any major knee injury but over the years multiple small insults took their toll, and at age 33 he was experiencing incidents of locking in his knees. At that stage he had an arthroscopic 'clean up' of the menisci.

Subsequent deterioration of both joints on their inner aspect, relating to the meniscus damage, resulted in marked bow-legs, and debilitating pain. At the age of 44 he was referred to Professor Wilson for consideration for osteotomy. It was decided not to tackle both knees at the same time, and in February 2015 he underwent a corrective osteotomy on the right knee.

On the left of this image you see the long-leg standing X-ray of the limbs at the beginning of the surgical planning. You can see the degree of bowing in both legs. The picture on the right is actually the same X-ray, but it shows the computer calculation of the amount of bone wedging that would be necessary to straighten his left leg (the image with the green lines) in the first osteotomy.

varus deformity planning

Right leg. February 2015.
High tibial osteotomy (large wedge) (PEEK plate)

This period of rehabilitation was a bit challenging. Firstly the long period of limited mobility meant that the muscles were weak. Then there was a complication of a superficial infection that required aggressive treatment to prevent infection going into the bone. After 7 months, the other leg was tackled. This time it was decided that the surgery would involve smaller re-alignments both above and blow the knee, rather the one large wedge that was done on the first knee.

after high tibial osteotomy

First procedure - high tibial osteotomy on patient's right leg

Left leg. September 2015.
Distal femoral osteotomy plus High tibial osteotomy

After the second procedure on the patient's left leg. The plate is more evident on these films, because it is metal whereas in the first operation a PEEK plate was used, which is made of carbon fibre and is less dense to the X-ray beam.

osteotomy post op X-ray from the side

The distal femoral osteotomy (DFO) is the procedure above the knee, and the high tibial osteotomies (HTO) are the procedures below the knee

HTO plus HTO-DFO

Walking unaided at 3 weeks after the second osteotomy

Then after a year from the second osteotomy, a third operation involved the removal of all the hardware - the plates and screws that were holding the bones in their new alignment.

Both legs. September 2016.
Removal of all hardware


21st September 2016
"I am currently two weeks post op from having all my metal work removed, back in the gym already and managed 30 mins on a bike. This op has been truly amazing and life changing, I spoke to Professor Wilson today and said I would be more than happy to talk to anyone who has issues or concerns about going for this approach, even setting up some form of support group - so I’m really hoping the videos I took will make a massive difference to those out there."

Gary Williams

Bow-legs may be corrected at the same time, or at different times, and a number of factors need to be taken into consideration:


bow legs (bilateral)
  • Marked deformity may require the bone to be cut and re-aligned both above and below the knee. This is a big procedure and it is a huge insult to the body to do it on both sides at the same time.
  • Correcting both bow-legs at the same time will put a burden on the patient in terms of getting around on crutches in those first weeks.
  • If one leg is straightened, and then a period of time allowed to elapse before the other is straightened, the altered gait will put strain on both legs and trunk.
  • The long period when the knees were bowed may mean that the muscles and tendons on the inner aspect become really taut once the leg is straightened. This may require a lot of stretching and massaging during rehabilitation.
  • Because the bone is cut and re-aligned, the plates and screws that fix the bone need to stay in place long enough for the bone to heal across the gap and become strong. Usually this hardware is only removed after a year.

Patient's 'vlog'
(after 2nd osteotomy but before removal of hardware)

Progress with rehab exercises...

For more information see The osteotomy Expert Group website.

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