Limb Lengthening Surgery – Most Frequently Asked Questions

1. What is limb lengthening surgery?

Limb Lengthening Surgery is done for cosmetic and medical purposes. The majority of patients (who are unhappy and want to be taller), however, opt for cosmetic procedures to increase their height. This process is carried out gradually, typically over several weeks, and hence, allows the soft tissues in your legs, like muscles, skin, and nerves, to gradually grow longer, as well as the leg bones, such as the tibia (shinbone) and femur (thigh bone).

2. Is limb lengthening surgery painful?

Like any other surgery, this procedure also may result in some pain. A little discomfort or soreness can also be felt throughout the healing period. You can get pain relief such as over-the-counter (OTC) pain medications after consulting with your healthcare provider.

3. How much height can be increased by limb lengthening surgery?

This surgery can lengthen a leg by up to 6 inches (15 centimeters). If more length is required, additional surgeries may be required.

4. Is limb lengthening surgery safe?

Patients considering limb-lengthening surgery must have a full discussion with their healthcare provider about these risks and potential problems. To reduce the risks involved with the surgery, patients should also ensure that it is carried out in a respectable medical facility by a certified and competent orthopedic surgeon.

5. What are the types of limb lengthening surgery?

• Ilizarov Method: This technique, in which the bones are fastened with tiny wires and rings, allows the bone segments to move in a controlled manner with the use of rods and hinges. This technique is based on lengthening a bone segment that has been broken by cutting from the bone once more to complete the cut portion. By using this technique, congenital shortness can be treated by lengthening the existing bone by 1 mm every day and achieving 30% of its bone length. Usually, the bone starts to lengthen seven to ten days later (It is typically applied as 0.25 mm every six hours and divided into 4 equal intervals of 1 mm every day).
• LON (The Combined Lengthening Over Nail): This technique uses both an external fixator and an intramedullary nail. The leg length can be consistently raised using the LON approach. The lengthening procedure is stopped after the desired leg length is attained, and the newly extended bones are allowed time to heal. Patients gradually develop the ability to walk during this consolidation (hardening) phase by placing their weight on the external fixator.
• Precice 2 METHOD: It’s an orthopedic extension nail that resembles a metal rod that locks together. It is placed into the bone canal via a little incision. The patient receives a unique remote control after the procedure. The magnetic motor inside the Precice gently extends when this control is pressed up against the leg. As a result, the bone lengthens together with the nail. It has controllability and accuracy.

6. What is the eligibility for the limb lengthening procedure?

A patient’s eligibility for limb lengthening surgery is determined by several variables, such as the particular ailment being treated, their general health, and their expectations and aspirations in life.

• Skeletal maturity: After skeletal maturity, which happens between the ages of 16 and 18 for boys and 14 to 16 for girls, limb lengthening surgery is usually carried out. This is so that the lengthening process does not obstruct normal growth, which depends on the growth plates in the bones being fully grown.
• Sufficient bone quality is necessary for candidates to assist in the lengthening process and guarantee appropriate recovery following surgery. Conditions affecting bone integrity or density may make someone ineligible for the surgery.
• Realistic expectation: Candidates should have reasonable expectations regarding the results of the procedure, taking into account the possible risks and consequences as well as the maximum lengthening that can be accomplished.
• Overall health: Candidates should be in good general health and free of any underlying medical disorders that could raise their risk of surgery or impede their ability to heal.
• Particular indication: Conditions including limb length discrepancy, congenital limb abnormalities, or specific types of dwarfism are usually suggested candidates for limb lengthening surgery.

7. What are the tests done before and after limb lengthening surgery?

Test before surgery for limb lengthening:

• Medical history and physical examination: To determine the patient’s general health and surgical suitability, a thorough medical history will be obtained, along with a physical examination.
• Imaging studies: X-rays, CT scans, or MRI scans can be carried out to plan the surgical approach, evaluate bone quality, and analyze the structure and alignment of the bones.
• Blood testing: To evaluate the patient’s overall health state, coagulation profile, and blood count, routine blood tests may be performed.
• Pre-operative education: Before, during, and after surgery, patients will be given information regarding the limb lengthening operation.

After Limb Lengthening Procedure:

• Post-operative imaging: To evaluate the alignment of the bones and track the healing of bone, X-rays or other imaging evaluations may be taken immediately following surgery and during the healing period.
• Frequent follow-up appointments: To track their recovery and make any adjustments to the lengthening devices, patients will see their orthopedic surgeon frequently.
• Physical therapy and rehabilitation: To strengthen muscles, increase joint mobility, and speed up the healing process, patients usually engage in physical therapy and rehabilitation exercises.
• Functional assessments: To assess the patient’s capacity to walk, bear weight, and carry out daily tasks, functional examinations may be carried out as the lengthening process advances and the bones mend.

8. What is the recovery period after limb lengthening surgery?

It usually takes nine to twelve months. However, depending on the patient and the surgical technique, the time required for a full recovery may vary. Several evaluations are done after the surgery to ensure that the bone is healing properly, such as:

• Tracking the development of bone healing by routine X-rays
• Avoiding high-impact sports and activities and gradually increasing your physical activity
• Contacting the medical staff and receiving help around the clock if necessary
• Taking preventative measures to minimize risks and consequences
• Paying attention to your body taking breaks as needed

9. How long does the procedure take?

The surgery typically takes five hours to complete. A patient can expect to stay in the hospital (post-operative care unit) for the next 2 days

10. Can limb lengthening surgeries be done together as a single procedure?

Yes, multiple limb lengthening surgeries can occasionally be done as a single treatment, especially if the patient needs limb abnormalities corrected or multiple bones need to be lengthened.

As the growth of bones ranges from 0.75 to 1 millimeter (0.04 inches) every day, other surgeries can be planned after some time. The bones are repositioned until they reach the appropriate length. The two fractured parts will gradually close the gap with the growth of new bone, known as regenerated bone.

11. What is the success rate of limb lengthening surgery?

The particular condition being treated, the method employed, the surgeon’s experience and the patient’s adherence to post-operative care and rehabilitation can all have an impact on the success rate of limb-lengthening surgery. In general, limb-lengthening surgery is thought to have a high success rate when carried out by skilled physicians on suitable patients.

12. What are the risks associated with limb lengthening surgery?

Like any surgical treatment, limb lengthening surgery has possible risks and complications. The following are a few typical risks for limb lengthening surgery:

• Infection: During or after surgery, there is a chance that the surgical site can get infected. From superficial wound infections to deeper infections affecting the bone or surrounding tissues, infections can take many different forms.
• Delay in bone healing: To promote the growth of new bone, a controlled fracture of the bone is created during limb lengthening surgery. Sometimes the healing process of the bone takes longer than anticipated, which can result in delayed consolidation.
• Damage to nerves and blood vessels: There is a chance that nearby nerves and blood vessels will sustain damage during the surgical process. This may result in symptoms in the affected limb, such as tingling, numbness, weakness, or poor circulation.
• Joint stiffness and contractures: Changes in joint structures and muscle function may result in joint stiffness or contractures.
• Complications associated with the device: Pin tract infections, hardware failure, and improper positioning of the device are among the issues that might arise from the use of internal implants or external fixation devices.
• Soft tissue complications: The surrounding muscles, tendons, and ligaments may undergo inflammation or rupture.
• Asymmetry, scarring, or variations in limb length are examples of cosmetic risks that may arise even after the desired length is reached.

13. How long do the scars last after the surgery?

After limb lengthening surgery, scars might appear differently and last longer in different people. The surgical method employed, the site of incisions, the patient’s skin type, and their body’s healing reaction may affect the recovery period:

• Healing phase: Scars may appear red, elevated, and noticeable just after surgery.
• Scar maturation: Although it varies from person to person, this process usually takes several months to a year or longer. Gradually, scars mature with time and become flatter, lighter in color, and less obvious.
• Scar treatment: Following limb-lengthening surgery, scar management procedures can help lighten the scars. It includes using silicone gel sheets, keeping the incision site moist and clean, and shielding the scar from the sun.
• Position of incisions: Scar visibility is significantly influenced by the position of incisions. To reduce exposure, surgeons make incisions in places where they can be readily covered up by clothing or naturally occurring wrinkles in the skin.
• Factors unique to each person: The way that scars emerge depends on their skin type and healing reaction. Age, heredity, and underlying medical issues are a few factors that may have an impact on how scars develop and change over time.

14. Are children eligible for limb lengthening surgery?

Yes, in some cases, children may be able to have surgery to lengthen their limbs. Children who suffer from disorders that impair their growth and development, such as limb length discrepancy, congenital limb abnormalities, or specific forms of dwarfism, may be candidates for limb lengthening surgery.

• Leg length inequality: Kids who have a large disparity in their limb lengths may have trouble standing, walking, and maintaining proper posture. Ankle lengthening surgery can help achieve limb equivalency and enhance general function.
• Congenital abnormalities: Certain children, such as those with clubfoot (talipes equinovarus), knock-knees (genu valgum), or bowlegs (genu varum), are born with limb deformities (to restore the alignment of the limbs and rectify these abnormalities)
• Hereditary problems: Achondroplasia and hypochondroplasia are two examples of hereditary abnormalities that can cause limb length disparities and short height (to improve overall body proportions and lengthen the limbs).
• Traumatic injuries: Children who suffer from traumatic injuries, like growth plate fractures or fractures, may grow more slowly or have unequal limb lengths (for normal growth and function)
• Functional restrictions: Children who suffer from limb abnormalities or length inequality may be unable to engage in daily activities, sports, or social interactions due to functional constraints (to enhance one’s range of motion, functionality, and quality of life

15. What is the importance of rehabilitation after limb lengthening surgery?

After limb-lengthening surgery, rehabilitation is important for several reasons:

• Regaining Function: Mobility and function can be greatly impacted by limb lengthening surgery. The goal of rehabilitation is to get the injured limb moving, strong, and flexible again.
• Preventing Complications: Contractures, joint stiffness, and muscle weakening are among the concerns associated with limb lengthening surgery.
• Maximizing Healing: The goal of rehabilitation procedures is to aid in the process of healing. Rehabilitative treatment encourages bone consolidation and tissue remodeling by progressively increasing weight-bearing and range-of-motion activities. By doing this, it is possible to attain the ideal limb length and alignment while reducing the risk of problems like non-union or delayed healing.
• Improving Psychological Well-Being: Surgery to extend the leg can be emotionally and physically taxing. Rehab builds confidence and encourages a sense of success through goal-setting and progress monitoring, both of which are critical for sustaining motivation and mental health.
• Long-Term Results: To ensure that patients attain the intended limb length without sacrificing function or placing undue strain on the surrounding tissues, proper rehabilitation can have a significant impact on long-term functional outcomes.

16. How is rehabilitation for limb lengthening surgery done?

In rehabilitation program, physiotherapy is performed to aid in the following ways:

• Early Mobilization: Following surgery, rehabilitation frequently starts with mild limb motions and range-of-motion exercises. This lessens edema, encourages blood flow, and helps avoid stiffness.
• Weight-Bearing Progression: The introduction of weight-bearing may be done gradually over time, depending on the nature of the limb-lengthening treatment and the surgeon’s recommendations. To support the affected leg, patients may initially require crutches, walkers, or braces. Gradually, they can go to partial and eventually full weight-bearing as tolerated.
• Muscle Strengthening: To target particular muscle groups and enhance general stability and function, rehabilitation programs often combine resistance training, functional exercises, and neuromuscular re-education.
• Flexibility and Stretching: Lengthening operations, especially in the vicinity of the surgical site, may cause joint and muscle stiffness and tightness. The rehabilitation plan includes stretches to maintain joint mobility, lessen muscle imbalances, and increase flexibility. Muscles surrounding the hip, knee, ankle, and foot can be targeted with stretches.
• Proprioception and Balance Training: Proprioception, or the body’s sense of joint position and movement, can be affected by limb lengthening surgery. Exercises for proprioception and balance assist patients in regaining awareness and control over their newly extended limb, which lowers their risk of falling and enhances their coordination.
• Functional Training: As patients make progress in their recovery, the emphasis is shifted to functional exercises that resemble tasks and motions found in everyday life. This may include squatting, walking, climbing stairs, and other exercises catered to the particular objectives and functional requirements of the patient.
• Pain Management: To reduce suffering and speed up healing, the rehabilitation program may include pain management therapies such as manual therapy, ice therapy, heat therapy, transcutaneous electrical nerve stimulation (TENS), and others.
• Patient Education and Support: Patients receive education and support from their healthcare team during the rehabilitation process to help them manage expectations, comprehend their treatment plan, and address any issues or worries they may have while recovering.

17. Can one run after limb lengthening surgery?

Although recovery times vary, patients should anticipate that the first few months following surgery will see a large amount of their recuperation. But going back to running or other high-impact exercises requires caution. It is suggested that physical activity be progressively resumed, beginning with low-impact activities and working your way up to higher-impact ones under expert supervision.

18. Does limb lengthening surgery make one look out of proportion?

Naturally, there are some limitations to a process such as this one. Your legs are the source of all your height gain, so your proportions can appear a little off, especially when you’re not wearing clothes. The healing process can also be difficult and long.

19. Who is the best surgeon for limb lengthening?

The following are the best limb-lengthening surgery specialists:

In India:

• Dr. Sudhir Mohan S (Aster Hospital, Delhi-NCR)
• Dr. Amar Sarin (Sri Balaji Action Medical Institute, New Delhi)
• Dr. Yash Gulati (Apollo Hospital, Delhi)

In Turkey:

• Op. Dr. Mehmet Aydogan (Medistanbul Hospital, Istanbul)
• Dr. Serdar Zengin (Acibadem Hospital, Istanbul)
• Dr. Yaman Ege (American Hospital, Istanbul)

In United Arab Emirates:

• Dr. Marc Najjar (Medcare Hospital, Sharjah)
• Dr. Chetan Prakash (Zulekha Hospital, Dubai)
• Dr. Sanjay Kumar Sureen (Prime Hospital, Dubai)

In United Kingdom:

• Dr. Nima Heidari (St. George’s Hospital, London)
• Dr. Hemant Sharma (Spire and East Riding Hospital, Hull)
• Dr. Paul Lee (Harley Street Medical Center, Lincolnshire)

In Spain:

• Dr. Javier Albinana (Quirosalud Madrid University Hospital, Madrird)
• Dr. Lluis Orozco Delclos (Teknon Medical Center, Barcelona)
• Dr. Mariano de Prado Serrano (Quironsalud Torrevieja Hospital, Torrevieja)