tag:theconversation.com,2011:/us/topics/knee-operation-32031/articlesKnee operation – The Conversation2017-09-17T19:41:51Ztag:theconversation.com,2011:article/839582017-09-17T19:41:51Z2017-09-17T19:41:51ZMost private patients are wasting money on costly rehab after major knee surgery<figure><img src="https://images.theconversation.com/files/186134/original/file-20170915-16328-1i7l3b6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Going home after a total knee replacement and having regular physiotherapy means you recover just as fast as if you'd chosen to stay in hospital for your rehab. And it's cheaper.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?src=iUfn6Ao_58FYDTdOJO61ZQ-1-40">from www.shutterstock.com</a></span></figcaption></figure><p>Most private patients who have had knee replacement surgery recover just as well with a cheaper form of rehabilitation than many are currently offered, research published today in the <a href="http://www.mja.com.au">Medical Journal of Australia</a> shows.</p>
<p>We found people who have had uncomplicated <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/knee-replacement-surgery">total knee arthroplasty</a> recover just as fast and with similar outcomes after out-patient rehab – which involves people leaving hospital and having regular visits to a physiotherapist – rather than the costly in-patient option, where patients stay in hospital for their rehab.</p>
<p>Not only could most private patients avoid up to two weeks in hospital, they could save themselves or their insurers several thousands of dollars.</p>
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Read more:
<a href="https://theconversation.com/confused-about-your-private-health-insurance-coverage-youre-not-alone-49493">Confused about your private health insurance coverage? You're not alone</a>
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<h2>What is knee arthroplasty?</h2>
<p><a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/knee-replacement-surgery">Knee arthroplasty</a> is major surgery, involving complex anaesthesia, removing the diseased knee joint and inserting artificial joint parts. Patients take a long time to recover; knee pain and swelling, and even muscle weakness, last for many months afterwards.</p>
<p>It’s a very common procedure. There’s a <a href="http://www.oarsijournal.com/article/S1063-4584(16)30400-9/abstract">one in five chance</a> of women having the procedure at some point in their lives; for men, that’s one in seven. The main reasons people have the surgery include severe knee pain or an unstable knee, mostly due to age-related osteoarthritis.</p>
<p><a href="https://aoanjrr.sahmri.com/knees">Over 50,000 knee arthroplasty surgeries</a> are performed in Australia each year, with <a href="https://aoanjrr.sahmri.com/documents/10180/275103/Analysis%20of%20State%20and%20Territory%20Health%20Data%20-%20All%20Arthroplasty">over two-thirds</a> in the private sector.</p>
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<a href="https://theconversation.com/surgery-isnt-always-the-best-option-and-the-decision-shouldnt-just-lie-with-the-doctor-64228">Surgery isn't always the best option, and the decision shouldn't just lie with the doctor</a>
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<p>The <a href="http://www.racgp.org.au/afp/2013/november/osteoarthritis/">number of procedures is rising</a> because more people have age-related osteoarthritis, partly because we are living longer and partly because we are becoming more overweight, which puts more pressure on the knees.</p>
<p>The surgery also seems to be safer than it used to be, <a href="http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/414360">including for elderly people</a>. So, anecdotally, people are opting to have the surgery now where before they may have thought it too risky.</p>
<h2>What rehab options are there?</h2>
<p>Rehab options after knee surgery can vary depending on whether you’re a public or private patient.</p>
<p><a href="http://www.acornregistry.org/images/2016%20ANNUAL%20REPORT%20SUPPLEMENTARY%20TABLE.pdf">In the public system</a>, in-patient rehab is generally reserved for patients who are too frail to go home, who have no support at home, or have had complications after surgery. Most public patients attend rehab as an out-patient.</p>
<p>But in-patient rehab is more common for <a href="https://www.surgeons.org/media/25492528/surgical-variance-reports-2017-orthopaedic-surgery.pdf">private patients</a>, whose surgeon may offer it as an option.</p>
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<span class="caption">Physiotherapy is the main form of rehab after knee replacement surgery.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/515526961?src=WDzphwE-vZZmbZF5utNGsg-1-44&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>While physiotherapy is the mainstay of formal rehab for both public and private patients, those who attend as an in-patient can also see other health professionals like rehab physicians, occupational therapists and nurses.</p>
<p>Private patients who choose in-patient rehab after knee surgery typically stay in hospital for 7-14 days. This adds another <a href="https://www.surgeons.org/media/25492528/surgical-variance-reports-2017-orthopaedic-surgery.pdf">A$9,500 or so to the median A$22,000 bill</a> for the surgery itself. By comparison, we found rehab as an out-patient costs just a median A$374.</p>
<h2>Which is better value for money?</h2>
<p>To find out which option gave private patients the best outcomes, we conducted a national study involving privately insured people who had undergone uncomplicated total knee arthroplasty. We then compared the outcomes between people who had in-patient therapy with those who went straight home.</p>
<p>People with significant complications following surgery, who progressed slowly in the early days after surgery, and people with limited help at home, were excluded from our study.</p>
<p>To ensure we compared apples with apples, we matched people who went to in-patient rehab with those who did not on many characteristics including age, gender, body-mass index (a measure of obesity), and the severity of disease before surgery.</p>
<p>We phoned people 35, 90 and 365 days after surgery and asked for details about their recovery and the types of rehabilitation they had.</p>
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<a href="https://theconversation.com/infographic-a-snapshot-of-private-health-insurance-in-australia-39237">INFOGRAPHIC: A snapshot of private health insurance in Australia</a>
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<p>People who received in-patient therapy reported similar knee-joint pain, and similar function and quality of life. Patients and their carers also took the same time off work regardless of the rehab option.</p>
<p>Median rehab costs for those who had in-patient therapy (A$9,978) were also much higher than costs for those who did not (A$374). The higher costs were due to the in-patient component, but, interestingly, also slightly more community-based therapy.</p>
<p>The main implication of our study is, given the cost difference between rehabilitation options, community-based (non-inpatient) alternatives seem to be better value.</p>
<h2>What do we make of all this?</h2>
<p>Our findings support our earlier trial <a href="http://jamanetwork.com/journals/jama/fullarticle/2610335">published this year</a>, as well as one by a Canadian team <a href="https://www.ncbi.nlm.nih.gov/pubmed/18676897">published</a> almost ten years ago.</p>
<p>Together, these studies suggest community-based rehab is better value for patients without complications, regardless of whether they are public or private patients.</p>
<p>We acknowledge that patients who receive in-patient rehab are <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2379-9">generally very satisfied with it</a>; they enjoy the convenience of the “one stop shop” and it may provide respite for carers. </p>
<p>However, we also know patients who go home <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2379-9">are also</a> <a href="http://jamanetwork.com/journals/jama/fullarticle/2610335">satisfied</a>; many surgeons and physiotherapists also rate community-based therapy <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2379-9">very highly</a>.</p>
<p>The challenge for researchers, health-care providers, governments, patients and
policymakers is to encourage the uptake of community-based therapies where appropriate so that in-patient rehab is reserved for those most in need. </p>
<p>If private sector rehab costs are kept in check, there is less pressure on health insurance premiums to rise. Hopefully, this in turn, encourages people to stay insured.</p>
<h2>How do I choose what’s best for me?</h2>
<p>To choose the best rehab option for you, here are three questions to ask your surgeon before your operation:</p>
<p>1) How do I know if I need in-patient rehab?</p>
<p>2) If I choose in-patient rehab, will I recover more quickly or better?</p>
<p>3) What are my rehab options other than as an in-patient?</p><img src="https://counter.theconversation.com/content/83958/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Justine Naylor has received funding from government (NHMRC, MAA) and non-government (HCF Research Foundation, Medibank) sources to conduct research studies. In the case of the non-government grants, the funder has not influenced the research question, study design or analysis.</span></em></p>Private patients who stay in hospital for costly rehab after major knee surgery recover just as fast as people who go home and have physiotherapy. So, why pay more?Justine Naylor, Associate Professor, South Western Sydney Clinical School, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/796592017-06-21T20:04:07Z2017-06-21T20:04:07ZSurgeons admit to mistakes in surgery and would use robots if they reduced the risks<figure><img src="https://images.theconversation.com/files/174829/original/file-20170621-26746-1ciui33.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Surgeons admit to unintentional mistakes when performing delicate surgery.</span> <span class="attribution"><span class="license">Author provided</span></span></figcaption></figure><p>How good are humans at performing manual surgery? </p>
<p>Major surgical errors must be reported and there has been research into the <a href="http://www.cbsnews.com/news/would-a-surgeon-tell-you-if-something-went-wrong-during-an-operation/">attitudes of surgeons</a> in how they report such errors.</p>
<p>But there is no requirement or legislation in place to report minor unintentional damage, and how that is even defined is a grey area. Very little research exists into the frequency of unintentional surgical damage, the challenges that cause this damage, or understanding of the long-term effects.</p>
<p>We are developing semi-autonomous robotic tools to help surgeons, especially for knee surgery. It’s estimated that around <a href="http://orthoinfo.aaos.org/PDFs/A00299.pdf">4 million</a> knee arthroscopies are performed each year worldwide. </p>
<p>In <a href="http://journals.sagepub.com/doi/10.1177/2309499016684993">our recent study</a>, some surgeons said they found that such knee procedures could be physically challenging and could cause unintentional damage to their patients. </p>
<p>But a majority said they would be prepared to use robotic tools if they could be shown to help in the surgery and reduce the risks of injury to patients.</p>
<h2>Unintentional damage in surgery</h2>
<p><a href="https://www.healthdirect.gov.au/osteoarthritis">Osteoarthritis</a> is by far the leading cause of pain in joints, especially knees.</p>
<p>Following X-ray and MRI scans, the first line of minimally invasive diagnostic and treatment procedures is known as <a href="http://orthoinfo.aaos.org/topic.cfm?topic=a00299">knee arthroscopy</a>. It is a procedure in which a surgeon slides a camera and a range of instruments into the joint through small incisions.</p>
<p>This procedure is somewhat controversial as the evidence of its effectiveness for some patients <a href="http://www.abc.net.au/health/features/stories/2015/03/25/4203985.htm">has been questioned</a>. But it is still one of the most common surgical procedures carried out in the world.</p>
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<span class="caption">Knee arthroscopy surgery showing a surgeon holding a patient’s leg.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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<p>With our colleagues, we asked 93 surgeons in Australia with a range of experience how often they observed unintentional damage occurring during a knee arthroscopy. The survey was anonymous and the results were <a href="http://journals.sagepub.com/doi/10.1177/2309499016684993">published earlier this year in the Journal of Orthopaedic Surgery</a>.</p>
<p>Half the surgeons (49.5%) said unintentional damage to articular cartilage, which is the tissue that covers the end of your bones that make up your joints, occurred in at least one in ten procedures.</p>
<p>A third (34.4%) of them said the damage rate was at least one in five procedures. Incredibly, seven of the surgeons (7.5%) said such damage occurred in every procedure carried out.</p>
<p>Damage to cartilage is probably <a href="http://www.arthritis.org/about-arthritis/types/osteoarthritis/causes.php">one of the causes of osteoarthritis</a> and your body does not repair cartilage if damaged, which can then result in knee pain.</p>
<p>So patients who suffer unintentional cartilage damage during an arthroscopy have an additional risk of developing osteoarthritis. This is somewhat ironic, given that the motivation for many arthroscopic procedures is to try to treat osteoarthritis.</p>
<h2>A pain for the surgeon</h2>
<p>Knee arthroscopy is considered straightforward, and a skilled surgeon will make it look easy. But it is actually very difficult and requires considerable <a href="http://bjj.boneandjoint.org.uk/content/97-B/10/1309.short">skill and experience</a>.</p>
<p>During the procedure, the leg must be manipulated to create the space for the camera and the tools. This means that the surgeon has to continually lift and hold the leg, while at the same time hold the camera and the tools and operate by looking at the video on a screen. </p>
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<span class="caption">The view from an arthroscope. Note the metal tool on the left of the image.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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<p>We asked the surgeons whether they found knee arthroscopy to be physically challenging, and whether they had experienced pain themselves after performing this surgery.</p>
<p>Nearly 59% reported they found the procedure to be physically challenging, and more than a fifth (22.6%) said they had experienced physical pain afterwards. It is in the interests of patients that their <a href="https://theconversation.com/you-should-care-about-your-doctors-health-because-it-matters-to-yours-78039">surgeons remain in good health</a>.</p>
<h2>Robots to the rescue</h2>
<p>So how can we reduce the risk of any unintentional damage during knee arthroscopy surgery and make the procedure less challenging for the surgeon?</p>
<p>At the moment there are no robotically assisted technologies used in knee arthroscopy. All the surgery is performed manually. </p>
<p>Our current research focuses on how robots can be used by surgeons to improve patient and surgeon safety, to reduce the need for future medical treatment, and to lower the costs of healthcare.</p>
<p>We are exploring how robots can be used to hold and move the leg during a knee arthroscopy, freeing the surgeon to focus on observing the interior of the knee. </p>
<p>We are also developing new types of flexible robots and tiny stereo cameras to replace the existing arthroscopes and which will feed into <a href="https://theconversation.com/how-do-robots-see-the-world-51205">robotic vision systems</a> to map the 3D structure of the knee. These 3D knee maps will be used by other tool holding robots to avoid colliding with the cartilage. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/5HBORi_LyYQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A prototype flexible ‘snake’ robot, designed to move around curved spaces like joints.</span></figcaption>
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<p>Our aim is to give surgeons semi-autonomous robotic tools so they can concentrate on what they are best at: deciding what is wrong with the patient and how to treat it.</p>
<p>About a third (32.3%) of surgeons<a href="http://journals.sagepub.com/doi/10.1177/2309499016684993"> we surveyed</a> said they were nervous about the introduction of any semi-autonomous arthroscopic systems.</p>
<p>But about three-quarters (76.3%) said they would use a robotic assist system if it improved the efficiency of the procedure, and 86% said they would use a robot if it decreased the rate of unintentional damage to cartilage.</p>
<p>Overall, 47.3% of the surgeons said they saw a future role for semi-autonomous arthroscopic systems.</p>
<p>All surgeons will tell you that surgery carries a risk. As a patient, you must balance the benefits of a given surgery against those risks.</p>
<p>Future upgrades to their toolkit in the form of robotic manipulators, scopes and tools, will hopefully allow surgeons to reduce the risks for both the patients and themselves.</p><img src="https://counter.theconversation.com/content/79659/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anjali Jaiprakash is an Advance Queensland Fellow and receives funding from Australia-India Strategic Research Fund.
</span></em></p><p class="fine-print"><em><span>Jonathan Roberts receives funding from the Australia-India Strategic Research Fund and the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Ross Crawford consults for Stryker Corp. He receives funding from ARC, NHMRC and Australia India Strategic Research fund</span></em></p>Surgeons say minor unintentional damage can happen during surgery, and much of that goes unreported. They say they would be prepared to use robotic tools if they could be shown to help.Anjali Jaiprakash, Advance Queensland Fellow, Medical Robotics, Queensland University of TechnologyJonathan Roberts, Professor in Robotics, Queensland University of TechnologyRoss Crawford, Professor of Orthopaedic Research, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/603662016-10-07T00:58:39Z2016-10-07T00:58:39ZExplainer: what causes knock knees and do they have to be treated?<figure><img src="https://images.theconversation.com/files/135108/original/image-20160823-30238-1ul0z13.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is it normal for kids' knees to knock together? When does it stop being normal?</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Knock knees, also known as genu valgum, is a type of knee alignment seen when a child (or adult) stands up straight with their knees together, but their feet and ankles stay apart. The opposite type of alignment, called bow legs (genu varum), is when someone stands with their feet and ankles together, and there is a gap between the knees. </p>
<p>Knock knees are usually assessed by directly measuring the angle of the shin bone to the thigh bone (tibiofemoral angle) or by measuring the distance between the ankles (intermalleolar distance). Sometimes photographs or x-rays can be taken to calculate these measures.</p>
<p>Knock knees (and bow legs) are a normal part of a child’s growth and development. The <a href="http://www.ncbi.nlm.nih.gov/pubmed/8459023">classic</a> pattern of changes at the knee with age in Caucasian children is bow legs at birth, straightening out at two years, going into knock knees at four years, and straightening out between six to 11 years.</p>
<p>There might be some ethnic and gender variation to the timing and severity of knock knees. For example, the knees of <a href="http://www.ncbi.nlm.nih.gov/pubmed/23946543">south Indian children</a> tend to straighten out sooner after birth, and go into knock knees earlier but with less severe angles. Girls seem to show a higher knock knee angle than boys at all ages.</p>
<p>However knock knees can be a problem. While most cases are a normal variant of growth (physiological knock knees), further investigation is needed (pathological knee knocks) if the knock knee angle is large, if they appear late or worsen after eight years of age, occur on only one leg, are painful or cause a limp. </p>
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<a href="https://images.theconversation.com/files/135109/original/image-20160823-30209-5q0doe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/135109/original/image-20160823-30209-5q0doe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/135109/original/image-20160823-30209-5q0doe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/135109/original/image-20160823-30209-5q0doe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/135109/original/image-20160823-30209-5q0doe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/135109/original/image-20160823-30209-5q0doe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/135109/original/image-20160823-30209-5q0doe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/135109/original/image-20160823-30209-5q0doe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Knock knees, normal legs and bow legs.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>What causes pathological knock knees?</h2>
<p>Pathological knock knees can occur in some neurological conditions, such as cerebral palsy or spina bifida, as a result of the altered muscle pull on the bones. </p>
<p>So pathological knock knees may be one of the early signs of an underlying disorder. Bone diseases resulting from poor mineralisation, such as <a href="http://www.ncbi.nlm.nih.gov/pubmed/15205623">rickets</a>, may present through large knee angles during childhood. When pathological knock knees are seen in combination with short stature and other bone and joint misalignment, a <a href="http://www.ncbi.nlm.nih.gov/pubmed/24432110">skeletal dysplasia</a> or <a href="http://www.ncbi.nlm.nih.gov/pubmed/18388709">metabolic bone disorder</a> may be the cause. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/26914720">Obesity</a> during adolescence is also associated with more severe knock knees, and is more commonly seen in children with <a href="https://theconversation.com/what-are-flat-feet-in-children-and-are-they-something-to-worry-about-60365">flat feet</a> and those with hypermobile (overly flexible) joints.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/135111/original/image-20160823-30252-2qvd27.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/135111/original/image-20160823-30252-2qvd27.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/135111/original/image-20160823-30252-2qvd27.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=364&fit=crop&dpr=1 600w, https://images.theconversation.com/files/135111/original/image-20160823-30252-2qvd27.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=364&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/135111/original/image-20160823-30252-2qvd27.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=364&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/135111/original/image-20160823-30252-2qvd27.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=457&fit=crop&dpr=1 754w, https://images.theconversation.com/files/135111/original/image-20160823-30252-2qvd27.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=457&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/135111/original/image-20160823-30252-2qvd27.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=457&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pathological knock knees.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
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</figure>
<h2>Do they have to be treated?</h2>
<p>It is usually parental concern for the way a child looks when standing or walking that sparks initial review by a health professional. Children presenting with physiological knock knees do not require treatment or ongoing monitoring, as they will grow out of it with time. </p>
<p>Conservative treatments may be beneficial such as <a href="http://www.ncbi.nlm.nih.gov/pubmed/26700568">exercises</a> and weight loss programs to reduce obesity and improve knee movement in children, or <a href="http://www.ncbi.nlm.nih.gov/pubmed/21273902">knee braces and foot orthoses</a> for painful osteoarthritis associated with knock knees in adults. However, these interventions require more scientific evidence to support their use as there currently isn’t much.</p>
<p>Children with severe or worsening pathological knock knees might need orthopaedic surgery to correct their knee alignment, particularly in the presence of persistent pain or disability, regardless of the underlying cause. </p>
<p>There are many operations for pathological knock knees. A hemiepiphysiodesis is a type of “guided growth” operation involving the placement of staples or a plate on the inside part of the knee to slow down growth while the outside part of the knee continues to grow. This then corrects the knee angle to a straighter position. A <a href="http://www.ncbi.nlm.nih.gov/pubmed/23965916">study</a> reporting outcomes two years after this operation showed correction in 34 of 38 knock knees. </p>
<p>Another surgical procedure for pathological knock knees is a wedge osteotomy, where the top of the shin bone or bottom of the thigh bone is cut and a small portion removed to correct the knee alignment. In a <a href="http://www.ncbi.nlm.nih.gov/pubmed/22706968">study</a> of 23 adolescents and adults with painful arthritic knock knees, a wedge osteotomy was found to show improvements in walking ability and alignment after two years. </p>
<p>Orthopaedic surgery is rarely needed. For most kids, knock knees are just a normal part of growing up.</p><img src="https://counter.theconversation.com/content/60366/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joshua Burns receives funding from NHMRC (National Health and Medical Research Council of Australia, Centre of Research Excellence #1031893, European Union Collaborative Research Scheme #1055131), NIH (Inherited Neuropathies Consortium RDCRC #U54NS065712 supported by NINDS/ORDR and NCATS), Muscular Dystrophy Association USA (#250931), CMT Association of Australia, Multiple Sclerosis Research Australia, Sydney Southeast Asia Centre, New Zealand Neuromuscular Research Foundation Trust, Thyne Reid Foundation, Elizabeth Lottie May Rosenthal Bone Bequest.. </span></em></p><p class="fine-print"><em><span>Verity Pacey receives funding from The Menzies Foundation, Arthritis Australia, Osteogenesis Imperfecta Society of Australia, Rheumatology Health Professionals Association and The Ian Potter Foundation.</span></em></p>Knock knees (and bow legs) are generally a normal part of a child’s growth and development. But if they persist, they can become problematic.Joshua Burns, Professor of Allied Health (Paediatrics), Children's Hospital at Westmead, University of SydneyVerity Pacey, Senior Physiotherapist, The Children's Hospital at Westmead, and Lecturer in Physiotherapy, , Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.