Frequently Asked Questions about Limb Lengthening Surgery

1.Is limb lengthening surgery safe?

Nowadays, limb lengthening surgery has become safer and easier thanks to the recent developments in orthopedic surgical techniques. The success rate of limb lengthening surgery is very high. It is completely safe when the operation and follow-up are performed by an experienced surgeon and medical team, and when the patient is followed well, especially during the lengthening period. It is very important to notice and prevent complications that may occur in the surgery and in the following process. After good management of these processes, patients can fully recover and reach their full physical capacity.

2.Is limb lengthening a painful process?

The pain during the hospitalization period after limb lengthening surgery is not extreme and is completely controlled with painkillers. There is usually no pain at the beginning of the extension period. When tension begins in the soft tissues, there may be a feeling of tension and pain associated with it. Pain level varies from person to person, but it is certainly not an excessive pain. If the technique is applied correctly, the mild to moderate painkillers would be enough. The appropriate physical therapy program and early mobilization will reduce the need of painkillers. Extreme pain is often a sign of a complication or technical incompetence.

3. Can anyone get limb lengthening surgery ?

Anyone who has leg length discrepancy with or without limb deformity can do this surgery.But if it is going to be performed only for cosmetic reasons, patients should have an age between 20 and 50. We prefer the individuals who are non-smokers, have good physical and mental health and candidates without any chronic diseases or hormonal problems. For smokers, quitting to smoke is definitely obligatory.

4. How is the limb lengthening surgery performed?

Limb lengthening surgery is basically performed to lengthen the bone tissue. Long bones are cut at an appropriate level with minimal invasive technique. We call that “osteotomy”. Surrounding soft tissues are preserved carefully. Surgeon will also apply an orthopedic lengthening device to the bone. Orthopedic lengthening devices that are inserted into the bone are called internal devices, such as the PRECICE nail. Orthopedic lengthening devices that remain outside of the body are called external fixators, such as the monorail fixator or the Circular (ilizarov) frame fixator. The ends of the osteotomized bone are distracted 1 mm per day using an orthopedic device (intramedullary nail or external fixator). While the patient is lengthening, the bone tissue tries to heal and fill this gap. The gradual lengthening is achieved during the distraction. When the desired bone length is achieved, the distraction is stopped and the bone is expected to heal completely.

5. What are the limb lengthening surgery techniques?

We basically divide all lengthening techniques in 3 groups.

  1. External technique: This is an external technique. External fixators are externally placed on the limb for lengthening. Lengthening is done with external fixator. The external fixator remains in the extremity until the bone has fully healed. It is no longer preferred in the field of cosmetic lengthening.
  2. Combined(LON) technique: It is also known as lengthening over nail. The external fixator and the internal nail are implanted into the bone simultaneously. Lengthening is done with external fixator. After the lengthening is finished, the external fixator is removed and the intramedullary nail begins to bear the body weight.
  3. Internal technique: This is known as the internal method. There is no external fixator on the limb. There is only a special motorized intramedullary nail with lengthening function inside the bone. Lengthening is done by external remote control system. It is the most comfortable and advanced limb lengthening technique.

6. What is the combined (LON) method?

This technique is named combined because it is a combination of internal and external bone fixation methods.Combined technique basically provides the lengthening of bone with a unilateral or circular external fixator over the intramedullary nail. After the lengthening is completed, the external fixator is removed and the nail is locked by the screws. So, the time that patient carries the fixator is shortened and the internal nail becomes weight bearing after removal.

7. What is the motorized nail (Internal) method?

Motorized nails are the most comfortable, less invasive and up-to-date technologies.There is no fixator outside, only an intramedullary nail is implanted into the bone. Therefore, the patient feels more comfortable and free to move. The risks of complications of internal method are less than the others. The motorized telescopic nail provides the lengthening with the help of an external remote controller. Patients can comfortably do the lengthening by themselves with this device.

8. How much can I lengthen each bone? What are the safe limits for cosmetic leg lengthening?

Unfortunately, there are optimum safe limits in cosmetic limb lengthening. The most important factor is the adaptation capacity of surrounding soft tissues such as muscles, nerves, vessels, tendons and ligaments. According to the literature, it is reasonable to limit the maximum 8 cm for femurs and 6 cm for tibias in order to avoid complications. Higher lengthening rates should only be aimed to achieve within the second surgery. Our major goal is to protect our patient’s full functional capacity during lengthening. Functions come before lengthening rate. So, we never do or let the patient do anything which will put my patient’s health at risk. Our goal is not only to make them taller but also to keep them healthy.

9. How long is the hospital stay in Limb Lengthening surgery?

If everything goes well, patients stay in the hospital for 5 to 10 days after the surgery. During this period, the patient is under observation for 24 hours. The patient gets medical and physical therapy, regular dressings are done and a brief introduction about the lengthening process is given to the patient.

10. What is optimal daily lengthening rate ?

According to experiences and scientific studies, average 1 mm per day is the optimum rate for leg lengthening. Soft tissues such as nerves, muscles, vessels, tendons and ligaments can adapt to the best in that rate. The daily lengthening amount can be changed by the surgeon according to some criteria such as the quality of the patient’s bone union, the tension level of the soft tissues with lengthening.

11. How much time is needed for limb lengthening process?

The amount and frequency of lengthening are closely related to the healing potential of the bone tissue. Lengthening starts on the 7-10th day after the surgery. No matter what method the patient uses for surgery, 1 mm lengthening is achieved in a day, so the patient will lengthen by 1 cm in every 10 days. So the 8 cm lengthening takes 80 days, the 7 cm lengthening takes 70 days and the 6 cm lengthening takes 60 days.

12. How long does it take to recover from limb lengthening ? When can I return to normal life?

The patients can return to their normal life within 6 months after the operation. Patient can walk and work in the office. However, the patient will be allowed to return to sports after 9 months. It is recommended to return to competitive sports after 1 year. Usually, 1-1.5 years after the surgery, bone and soft tissue healing is completed and the patient reaches full physical capacity.

13. When can I walk after limb lengthening surgery ?

On the 1st day after the operation, the patient can stand up and walk. The patient is not allowed to walk with whole-body weight. A walker is used to support the patient’s walking. The walking protocol is taught to the patient according to the method applied, the patient’s body weight and the durability of the orthopedic device used. During the lengthening period, the patient can walk by following this protocol.

14. What are the most important steps in limb lengthening surgery ?

Limb lengthening surgery has three important steps. Planning, surgery and follow-up. These three steps are very crucial and closely related to each other. One can not be fully completed without the other. Detailed and correct planning makes the surgery easier. Meticulous surgical technique increases success rate and reduces risks. Regular follow up periods keep the surgeon awake against complications before it’s too late. All is necessary for successful lengthening.

15. Is There Any Age Limit for Limb Lengthening Surgery ? What is the best age to get limb lengthening ?

Bone and soft tissue healing capacity is much higher at younger ages. Therefore, having surgery as young as possible greatly reduces the risk of complications. If limb lengthening surgery is going to be performed only for cosmetic reasons, patients should have an age between 20 and 50. In order for the lengthening surgery to be performed in young people, the height growth must be stopped. Height growth usually stops at the age of 18-20. However, in some people, height growth continues after the age of 18. Whether the lengthening continues or not is decided by looking at the condition of the epiphyseal plate in the bones. The closure (ossification) of the epiphyseal plate, which can be seen easily on the x-ray, means that the lengthening has stopped, and limb lengthening surgery can be performed. The status of bone quality is important in determining the upper age limit. As age progresses, bone quality decreases and bone resorption increases. This means that the bone of the person who has had lengthening surgery will have difficulty in union. Generally, limb lengthening surgery is not preferred for people over 50 years old.