Limb length discrepancies, in which one leg or arm is shorter than the other, can happen for a variety of causes. A disease that causes one limb to grow more slowly than the other may be present at birth. After a complicated fracture or a fracture that heals poorly, an arm or leg may stop developing. Alternatively, surgery to remove a bone cyst may prevent that limb from growing normally. Leg lengthening surgery may be a possibility in such circumstances.
Over the years, Drs. James Kasser, Carley Vuillermin, and Collin May have extended several patients’ legs and arms. They’ve been at the forefront of adopting innovative technology that have enhanced patient experience and outcomes as orthopedic surgeons in Boston Children’s Hospital’s Limb Lengthening and Reconstruction Program. While limb lengthening is beneficial to many of their patients, these clinicians make it plain that treatment is not for everyone.
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What’s the Process of Limb Lengthening Surgery?
Dr. Vuillermin: Limb lengthening causes the bones in a patient’s leg or arm to grow longer. We do this by cutting the bone with a knife and attaching a device that slowly moves the two ends of the bone apart. As the space between these two ends gets bigger, new bone grows to fill it. Patients often go through several lengthening cycles over the course of a few years, depending on their age, growth stage, and how much lengthening they need.
Most of the time, limb lengthening is used to fix a difference in leg length. The goal of leg lengthening is to make the body level so that back, hip, and knee problems that can come from walking on legs that aren’t the same length don’t happen. Most differences in arm length don’t make this big of a difference. Lengthening is only thought of when a shorter arm makes it hard to do everyday things.
Candidates for cosmetic height-increasing surgery must be well-informed, very motivated, and able to pay for it. To be considered, you must be in good health, have never smoked, and have a fully developed skeleton. All candidates should be mentally stable and have their family’s support. We don’t have specific initial height requirements because we look at each person on their own.
What is the success rate of Limb Lengthening Surgery?
Overall, limb lengthening procedures are very successful (about 95 percent ). Scarring is usually minimal because most operations only need tiny incisions. Although pins and stiffness in the joints can cause minor issues, major complications after limb lengthening surgery are uncommon.
Dr. Kasser: There are some significant dangers. Nerve injury, muscle damage, joint contracture, dislocations, and arthritis are all risks associated with limb lengthening. We make sure our patients are aware of this as they consider their alternatives. We can avoid or significantly reduce the difficulties that are inherent in lengthening operations by monitoring the lengthening process and modifying it as needed.
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Which bones will have their length increased?
Doctors advocate extending both femur (thigh) bones at the same time. During one surgery, two femoral Precice internal devices are implanted. A year following femoral lengthening, the tibia (shin) bones can be lengthened as a separate surgery.
In the thigh bone, a complete lengthening of 2-3 inches (5-8 cm) is indicated (femur). More than 3 inches of bone lengthening is linked to a higher risk of complications, thus our experts priorities patient safety. If desired, a further lengthening treatment in the shin bones (tibiae) can be performed one year later to achieve an extra 2-3 inches (5-8 cm) of height.
Is there any alternative to Limb Lengthening Surgery?
Prosthetic management is another possibility. In rare circumstances, a prosthesis can be customized to a patient’s deformed limb to increase movement. Amputation of the shorter limb is sometimes necessary. While this may appear severe, amputation is the best option for many people. With prosthetic limbs, many of our patients who had amputations are now running around, participating in competitive athletics, or just doing what kids do.
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