• Leg Lengthening

    Definition

    This procedure corrects a leg length difference. With surgery and devices, a bone can be lengthened over a period of time. The process triggers bone growth and soft tissue lengthening.

    Reasons for Procedure

    Lengthening may be needed if you have a length difference due to:
    • Trauma (eg, leg fracture )
    • Bone infection
    • Tumors
    • Congenital defect or other condition that affects your bones
    • Short stature (eg, dwarfism )
    If the difference is not corrected, it can cause excess strain on joints. You could have pain in your knee, hip, or ankle. You may develop osteoarthritis and back pain.
    Correcting the problem can help improve walking and reduce your risk of other problems. Depending on the technique, several inches may be added.

    Possible Complications

    Your doctor will review a list of possible complications, like:
    • Excess bleeding
    • Adverse reaction to anesthesia
    • Infection (may be around the pins or wires that are inserted during the procedure)
    • Blood clots
    • Nausea and vomiting
    • Joint stiffness
    • Bone length may not be exact (eg, longer or shorter than planned)
    • Muscle contraction (muscle shortens)
    • Nerve injury
    • Problems with the new bone forming
    Discuss these risks with your doctor.

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    • A physical exam
    • Measure your legs
    • Take x-rays
    Before the surgery, you will:
      Talk to your doctor about your medicines—You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Aspirin or other anti-inflammatory drugs
      • Blood thinners
    • Avoid eating or drinking after midnight the night before surgery.

    Anesthesia

    Options include:

    Description of the Procedure

    This procedure will be done in stages. The first stage is a procedure called an osteotomy . The doctor will make an incision in the leg and cut the bone. The doctor will select a fixation device for the leg. This will stabilize the bone while it is being lengthened. Options include:
    • External fixation device—This framed device is positioned around the leg. Pins and wires are placed through the skin and tissue to reach the bone and lengthen it. Some have a dial attached to the frame. This dial is turned to slowly lengthen the bone.
    • Internal fixation device—This is placed inside the leg. It is positioned on the bone. Some of these devices have a nail with a tool that automatically lengthens the bone. In other cases, it is used with the external device.
    External Fixation Device
    Copyright © Nucleus Medical Media, Inc.
    Lengthening will be done at a rate of about 1 millimeter (mm) per day. This stage may start a few days or weeks after the osteotomy and last for a couple of months. Depending on your device, you will adjust it several times during the day. Your body will slowly regenerate new bone in the small space that was created between the bone ends.
    During the next stage, your bone will heal. You will be able to put more weight on your limb. X-rays will be taken. When the healing process is completed, the fixation devices will be removed.

    Immediately After Procedure

    You will stay in the recovery room for several hours.

    How Long Will It Take?

    The osteotomy can take about two hours. This depends on the extent of the surgery. The lengthening process can take 2-3 months.

    How Much Will It Hurt?

    Anesthesia prevents pain during surgery. Your doctor will give you pain medicine after surgery. You may have discomfort from the fixation devices.

    Average Hospital Stay

    The surgery is done in a hospital. The usual length of stay is 1-3 days.

    Post-procedure Care

    At the Hospital
    At the hospital, the staff will:
    • Give medicine to prevent blood clots
    • Have you breathe deeply and cough regularly to prevent fluid build-up in the lungs
    • Encourage you to get out of bed and walk using crutches or a walker
    • Have you start physical therapy the day after surgery
    • Teach you how to adjust the fixation devices
    • Teach you how to care for the pin and wire sites for an external fixation device
    At Home
    Leg lengthening will take place at home. For a smooth recovery:
    • Use crutches or a walker. Do not put weight on your leg until your doctor gives you permission.
    • If you have a device that needs to be adjusted, carefully adjust it throughout the day as instructed.
    • Keep the external fixation device clean, especially around the pins and wires, to prevent infection.
    • Keep the incision area clean and dry.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Work with a physical therapist. He will focus on stretching and strengthening your leg.
    • Take pain medicine as directed.
    • Go to all of your follow-up appointments. You will need to have x-rays taken every 2-3 weeks to monitor bone growth.
    • Eat a healthy diet. If instructed, take calcium supplements.
    The entire process can take up to six months.

    Call Your Doctor

    Contact your doctor if any of the following occurs:
    • Signs of infection (eg, fever, chills)
    • Redness, swelling, increasing pain, excessive bleeding, or discharge around the incision or pin and wire sites
    • Pain and/or swelling in the feet, calves, or legs
    • Pain that you cannot control with the medicine you were given
    • Cough, shortness of breath, chest pain
    • Severe nausea or vomiting
    • Numbness, tingling, or loss of feeling in your leg, knee, or foot
    • Pain, burning, urgency or frequency of urination, or persistent bleeding in urine
    • Problems or concerns about the fixation devices
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org/

    American Orthopaedic Association http://www.aoassn.org/

    CANADIAN RESOURCES

    The Arthritis Society http://www.arthritis.ca/

    Canadian Orthopaedic Association http://www.coa-aco.org/

    References

    Limb length discrepancy. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00259 . Updated July 2007. Accessed November 29, 2010.

    Limb lengthening. International Deformity and Lengthening Institute website. Available at: http://www.ilizarov.org/ll.pdf . Accessed November 29, 2010.

    Limb lengthening. Scottish Rite Hospital for Children website. Available at: http://www.tsrhc.org/limb-lengthening.htm . Accessed November 29, 2010.

    The New York Institute for limb lengthening and reconstruction. NYU Hospital for Joint Disease website. Available at: http://www.med.nyu.edu/hjd/centerforchildren/patient/limb.html . Accessed November 29, 2010.

    Paley D. Limb lengthening introduction. Limb Lengthening.us website. Available at: http://www.limblengtheningdoc.org/limb%5Flengthening%5Fintro.html . Accessed November 29, 2010.

    Rozbruch R. Limb lengthening an overview. Hospital for Special Surgery website. Available at: http://www.hss.edu/conditions%5Flimb-lengthening-overview.asp . Updated January 24, 2003. Accessed November 29, 2010.

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