Deformity correction surgery

Deformity correction is a type of surgery that straightens bones that are crooked, curved, or bent in an abnormal or unusual way. It typically involves surgical fracture of a bone and then realigning it into its proper position. Deformity correction surgery is used to relieve pain and improve function for diseases of the bones and may also be used to treat traumatic injuries. It can correct deformities in different areas of the body like the spine, legs, or arms and is commonly used to treat scoliosis, club feet, bowlegs, and other conditions related to misshapen bones.

Penn Medicine’s multidisciplinary team of orthopaedic surgeons, microvascular surgeons, and physical and occupational therapists work together with you to create a treatment plan. We focus on an approach that provides pain relief and meets your lifestyle goals. Whenever possible, we use minimally invasive techniques that result in shorter hospital stays, fewer complications, smaller incisions, reduced blood loss, and less overall pain.

There are two common approaches to deformity correction surgery. Your orthopaedic surgeon will assess your specific case and decide on the best approach based on the severity and complexity of the deformity.

• Acute correction: This approach is typically used for mild or moderate deformities and can be completed in the shortest amount of time. Using one procedure, a surgeon will fracture the deformed bone and realign it into the proper position. Soft tissues, such as nerves and muscles, may also be reconfigured to support the new bone structure. An internal device, like a metal plate, is typically implanted to keep the bone straight and support its new position. Once the bone is fully healed, follow-up surgery may be required to remove the internal device.
• Gradual correction: This process may require weeks or months to complete and is typically used for more severe or complex deformity correction. First, a surgeon applies a metal device, called an external fixator, on the outside of your body and attaches it through wires or threading to the bone. Your deformed bone is then surgically cut and placed in the proper position. Nerves, muscles, and other soft tissues may be repaired at the same time to help support optimal healing around the bone. The external fixator is then adjusted slowly over time to straighten the bone. This allows new bone to grow between the broken pieces at a rate that is optimal for healing. This approach straightens a bone in stages, as incremental adjustments are made with the external fixator.

When nonsurgical approaches like physical therapy, cortisone injections, bracing, and pain management do not provide relief for a mishappened bone, you may be a candidate for corrective orthopaedic surgery. Your doctor will perform a physical exam, order imaging tests, and review your symptoms and overall health to assess whether correction surgery is right for you. They’ll focus on whether deformity correction surgery is likely to relieve your symptoms to reduce pain and improve function.

Some conditions commonly treated with deformity correction surgery, include:

• Scoliosis
• Kyphosis
• Clubfoot
• Cleft foot
• Knock knees
• Bowlegs
• Limb length inequality

Correction surgery techniques vary based on the affected area and the complexity of the deformity and its repair. You may need one or more surgeries to complete the reconstruction of deformed bones. Your doctor will advise you on the approach to surgically fracture a bone to correct your specific deformity.

While individual steps may vary depending on the surgery, they often include these phases:

• You’ll have general anesthesia to make you sleep, or local anesthesia to numb the area surrounding the surgery. You’ll remain pain-free throughout the procedure.
• A surgical fracture of a bone (osteotomy) will be used to cut the bone into pieces and the surgeon will move pieces of bone into their optimal position.
• Soft tissues, like nerves or muscles, may be bolstered to support the new shape of the bone to create the best environment for healing.
• For acute correction surgeries, your surgeon may insert an implant, like a metal rod, to stabilize the bone and keep it in the correct position temporarily. This implant may be removed later once the bone has fully hardened and healed.
• For gradual correction surgeries, an external fixator will be placed on the outside of your body and attached to the bones prior to surgical fracture and reconstruction of the bone. You’ll receive instructions on how and when to adjust the external fixator to make incremental adjustments that help the bone grow slowly into the proper position. When healing is complete, the external fixator is removed in a separate procedure.
• You’ll have regular follow-up appointments with your surgical team to ensure that your healing is on track and to discuss questions or concerns you have.
• Once your healing has progressed, you’ll start physical therapy and have a step-by-step plan to help you return to your regular daily activities.

The recovery time for deformity correction surgery varies based on the type of surgery, the affected area of the body, and the complexity of the reconstruction. Recovery time can range from several weeks to several months or longer.

You can expect some of these common experiences during your recovery:

• You may have pain around the surgery site for several weeks after your procedure. Your doctor will create a pain management plan for you that includes prescription medications and over-the-counter drugs that will help you stay comfortable as you heal.
• Your doctor will likely recommend that you wear supportive devices to keep the bone safe and protected. For example, you may use crutches, braces, or splints for a time.
• Your physical therapy team will create a detailed plan to help you regain your function and mobility. You may need to attend therapy sessions multiple times a week. It’s important to follow the home exercises to recover fully. Be sure to ask questions if you are unclear about any instructions.
• Do everything you can to nourish your body during the recovery stage to support healing. Focus on eating a healthy diet and avoid the use of nicotine and alcohol.
• Contact your doctor if you have any unusual pain, bleeding, swelling, or other concerning symptoms. They can provide additional information or resources to alleviate any concerns and help you heal faster.

When performed by experienced orthopaedic surgeons, deformity correction surgery is safe and can produce successful outcomes. As with any surgery, there are risks of infection, blood clots, or complications from anesthesia. Some risks particular to deformity correction surgery include:

• Nerve damage
• Bones that do not heal correctly (malunion or nonunion)
• Limited range of motion or function

Your doctor will discuss these risks with you before surgery.

Penn Medicine’s orthopaedic team is highly experienced in acute and gradual deformity correction surgeries. Our orthopaedic surgeons and physicians work across multiple disciplines, including physical medicine and rehabilitation (PM&R), neurosurgery, microvascular surgery, and pain management. We create individual treatment plans that consider every aspect of your care to address even the most complex deformity correction operations.

When you come to Penn Medicine for deformity correction surgery, you can expect:

• Specialized care: Our surgeons treat deformities in different areas of the body, whether it’s in the spine, legs, arms, feet or other areas. You can be confident that we have the expertise to provide you with the care you need.
• Minimally invasive techniques: Whenever possible, we perform procedures, like an osteotomy, using smaller incisions and tiny surgical instruments to help you heal faster and avoid complications.
• A whole-body approach: We surround you with your own dedicated team of specialists who work with you to understand your needs and how you want to live so we can develop the most appropriate care plan for you.
• Second opinion program: You may want to consider all of your options before proceeding with deformity correction surgery. The Penn Medicine orthopaedic team can discuss the details of your diagnosis and treatment plan to give you peace of mind when determining the best path for you.