The Long and Short of Limb Lengthening Surgery
If you were born with a limb defect or are self-conscious about your short stature, limb lengthening surgery may be something you’ve taken into consideration. This article covers everything you need to know about this procedure, including the different leg lengthening techniques, recovery time, and making sure you’ve chosen the right, experienced surgeon.
Limb lengthening procedures have come a long way since their advent in the early 1980s, with new devices and techniques seemingly emerging every day. But one thing remains a constant with every new advancement: limb lengthening requires the combination of technology and the body’s ability to regrow new bone — under the careful guidance of an orthopedic surgeon and special devices — in order for patients to achieve longer legs.
There are two common types of leg lengthening procedures, both of which require the cutting of the bone and implementing a stabilizing apparatus, which is either implanted inside the bone (internal leg lengthening) or worn outside the limb (external leg lengthening) to lengthen the legs and correct deformities.
External Leg Lengthening
Contemporary limb lengthening surgeries use the anatomy to encourage the growth of new bone as well as tissues, blood vessels, ligaments and nerves. These techniques have only been common for a few decades in the United States, and actually grew out of an earlier procedure developed in Europe roughly 25 years ago.
In 1982, Gavril Ilizarov, a Soviet physician, invented an external fixator device called the Ilizarov apparatus for lengthening limb bones. The Ilizarov technique was a major breakthrough in limb lengthening, as it allowed for the orthopedic surgeon to hold the bone in place during and after surgery to ensure correct alignment and encourage the growth of new bone. The practice of using an external device, such as the Ilizarov apparatus, is referred to as “external leg lengthening.”
The innovative surgery begins with an osteotomy, the procedure of cutting or removing a piece of bone, and then requires a procedure to help stabilize the limb with a fixation device or frame, which is often the Ilizarov apparatus.
The surgery is typically performed under general anesthesia. After surgery, the patient will be required to adjust the device each day to encourage the bones to lengthen according to the device. Coupled with physical therapy, this procedure can increase the length of the bone by 25 to 30 percent. In many cases, this equates to approximately 3 to 3.5 inches of extra bone growth.
Borrowing components from the Ilizarov technique, lengthening over nails (LON) is a newer leg lengthening method first popularized in 1990 by Dr. Dror Paley. This special surgery requires a hole be made through the bone in order to provide space for a small nail, which is then attached to an Ilizarov apparatus. Following surgery, the patient slowly turn the screws to gradually stretch the bones over the nail.
Other external fixator devices, such as a monorail fixator or a Salamehfix, are also used for external limb lengthening procedures.
There are some instances where a doctor will recommend lengthening and then nailing (LATN), combining elements of external and internal leg lengthening procedures into a single surgery. This procedure was developed by S. Robert Rozbruch, MD, Chief of the Limb Lengthening and Complex Reconstruction Service at the Hospital for Special Surgery in New York City.
“With LATN, lengthening is done with the external fixator,” Dr. Rozbruch explains. “A nail is then inserted so that the external device may be removed quicker, even before the bone is fully united. However, the internal lengthening nail method has for the most part replaced LATN.”
Internal Leg Lengthening
If the idea of wearing a cumbersome external device for several months sounds unappealing, you might want to consider some of the more contemporary internal limb lengthening techniques. There are now cutting-edge technologies that lengthen the bone from the inside, like the Precice® System from Ellipse Technologies and the Fitbone® SAA from Wittenstein.
Precice is an internal limb lengthening device that requires the surgical implantation of a titanium rod into the bone cavity, which is then lengthened by handheld screws. The device is removed after one or two years time through a relatively minor outpatient procedure. It can lengthen the bone by up to 3 inches.
Fitbone is another intramedullary lengthening nail, which allows the patient to lengthen the femur (thigh bone) and tibia (shinbone) in instances of leg length discrepancies and other serious deformities of the leg bones. This device is implanted into the bone and features a telescopic, electric nail that forces the bone to grow.
Compared with the Precise nail, Fitbone claims to offer less scarring. After complete consolidation of the bone, i.e. 12 to 18 months after implantation, the Fitbone must be explanted. It can achieve lengthening of up to 60 millimeters in the tibia and 80 millimeters in the femur.
Limb Lengthening Recovery
Depending on which type of surgery you choose, recovery times can vary. Regardless of whether an internal or external lengthening device is used, there will be a lengthy period of recovery, called the “consolidation phase.”
Children are required to wear a leg lengthening device for roughly three months, while adults need to wear one for about six months. The procedure can be painful, so your doctor is likely to prescribe you painkillers in order to keep the recovery process running smoothly.
Both kids and adults are required to undergo physical therapy in order to keep their joints flexible and encourage the maintenance of muscle strength. Additionally, your doctor may recommend taking calcium supplements to hasten bone healing and growth.
Some doctors may also recommend a weight-bearing device that uses a painless, electromagnetic field to encourage muscles and bones to regain their strength quickly. The entire complex reconstruction process should be complete within six months time for healthy adults. Throughout this period, regular physical therapy and follow-up visits will be required.
Who is a Candidate for Leg Lengthening Surgery?
The most common candidates for limb lengthening are people with birth defects, knock-knees, foot and/or bowleg deformities, limb length discrepancy, and most other leg deformities. This procedure is also common among people with fractures or broken bones that didn’t heal properly (malunion or nonunion) and those with dwarfism.
Besides the cosmetic benefits, some patients undergo leg lengthening surgery when they’ve experienced long-term issues associated with their defect, including arthritis. In these instances, as well as with cases of deformities, the procedure is likely to be covered by insurance.
With pediatric leg lengthening, a doctor will first observe the growth plate (the area of the bone that indicates how much the bone will grow) to determine whether leg lengthening is the best solution. Children with differences in limb lengths and a myriad of other deformities are often good candidates for limb lengthening procedures.
According to the Hospital for Special Surgery, children who have limb lengthening procedures heal in roughly half the time it takes adults to recover. Pediatric patients typically have the same options as adults when it comes to lengthening devices. They also typically see better results, with the ability to lengthen bone by up to 8 inches.
Although once reserved for those with congenital anomalies and developmental disorders, limb lengthening surgery has since become popular for cosmetic purposes as well. The procedure is largely the same for those who undergo it primarily for aesthetic reasons.
Generally speaking, when the patient has a medical need — such as the risk of arthritis or other physical drawbacks resulting from deformities and other issues — there’s a good chance it will be covered by insurance. However, it’s unlikely that you’ll be able to get your insurance to cover the process if you are undergoing it strictly for cosmetic purposes.
The Best Surgeons for the Procedure
- How many patients have you treated for elective bilateral leg lengthening?
- Which techniques do you use?
- How much do you currently charge for bilateral leg lengthening on one bone section?
- What are the lengthening limits for your procedures?
- Do your patients need to do any preparation before for their treatment?
- Is accommodation included in your pricing?
- Are there any medical conditions that would prevent a potential patient from being accepted?
- In what percentage of cases do your patients experience complications?
- Are complications or unscheduled surgery covered in your costs?
- Is there any insurance available to cover the patient’s treatment?
- What is your official website?
- How much do you charge for a consultation?
- Do you limit your services to people of a certain height?
- What is your policy for people who are suffering from depression or some other mental health issue, or have suffered from it in the past?
One of the preeminent surgeons to perform limb lengthening is Dr. S. Robert Rozbruch, the chief of the Limb Lengthening and Complex Reconstruction Surgery at the Hospital for Special Surgery (HSS) in New York City and New Jersey. Dr. Rozbruch has contributed to a breadth of research on both orthopedic surgery and cosmetic surgery as it pertains to limb lengthening.
Dr. Austin T. Fragomen is another orthopedic surgeon at HSS who specializes in the procedure at the Limb Salvage and Amputation Reconstruction Center (LSARC). Dr. Fragomen’s specialty pertains to limb deformity correction and bone lengthening surgery.
Those in search of a reliable cosmetic leg lengthening surgeon will also want to consider the Stature Lengthening Center at the Orthopedic and Spine Institute in West Palm Beach, Florida. Surgeons at the Stature Lengthening Center use the Paley method and the Precice device to perform internal leg lengthening procedures.
Dr. Amar Sarin in Delhi, India is another leading specialist in the field. Dr. Sarin specializes in the Ilizarov technique and has performed over 3,000 leg lengthening procedures in the past 20 years.
While limb lengthening remains a relatively uncommon medical procedure, several experienced surgeons perform it in the United States and abroad. Begin your research by using the American Academy of Orthopaedic Surgeons’ directory. Founded in 1933, the Academy is the preeminent provider of musculoskeletal education to orthopaedic surgeons and others in the world.
Ask a Cosmetic Doctor on Zwivel
Got a question about a cosmetic treatment? With over 2,000 doctor answers and counting, the Zwivel forum is the best place to get expert professional opinions.
Hundreds of questions have already been answered: