leg lengthening

Everything About Leg Lengthening Surgery in Singapore

Leg lengthening and reconstruction can be performed using the either the internal method (known as the Intramedullary Skeletal Kinetic Distractor (ISKD) technique and precise nail) or the external method (known as the monolateral fixator, or lengthening and then nailing – LATN technique). Patients who look to lengthen their legs to improve their body image can choose to have this sophisticated procedure done in Singapore.

1. How can bone be lengthened?

Bone lengthening has been performed for many years using various techniques including Wagner and Hoffman methods. This was associated with significantly high complications.

The recent Ilizarov technique has improved results. It involves distraction of cut bone ends at 1mm per day resultant in bone regeneration. The soft tissue including skin, nerve and vessels also lengthens gradually during this procedure.

2. What are the common indications for the leg lengthening procedure?

The Ilizarov technique has been used successfully for many years to treat adult and pediatric cases of bone loss, limb shortening and deformity. The main disadvantage is that an external fixator that was used had problems of pin tract infection, nerve and soft tissue irritation and discomfort during treatment. Cosmetic lengthening was not offered because of this risk.

The kinetic distractor utilizes the same principles but has significant advantages since it is entirely implantable. The risks are minimized and therefore it can be used for medical and cosmetic lengthening/deformity correction.

leg lengthening

3. Can bone be lengthened by medical methods?

Growth hormones have been used in young children with dwarfism. However, it is expensive and has serious sides effects like pituitary dysfunction/tumor induction, type 2 diabetes mellitus and acromegaly. It cannot induce bone growth in adults.

4. What are the pre-operative preparations? 

Before the operation, the patient is instructed about the application of this technique and postoperative care.

A weight bearing X-ray of both lower limbs is required. Routine screening for any patient for general anesthesia is done. Blood tests and chest X-rays are not screened unless there are some medical problems.

A preoperative screening by psychologist or psychiatrist is mandatory requirement in Singapore (consultation will be arranged and costs about USD120) only for cosmetic lengthening cases.

5. What are the differences between the internal method and external method?

a. Internal method: Intramedullary skeletal kinetic distractor (ISKD)

Intramedullary Skeletal Kinetic Distractor is a technique in which the rod is inserted and screwed to the bone. It involves one direction to rotate the leg and the rod lengthens, expanding the leg and thus allowing the new bone to develop gradually.

Depending on the indication, the device can insert unilaterally or bilaterally, into the femur or tibia.

The surgery usually taken between 2 to 4 hours depending on number of limbs involved. Patient has to stay in the hospital for 5 to 7 days.

b. External method:

  • First surgery: Leg lengthening surgery using monolateral fixator

This is an external method using monolateral fixator where the effect of distraction is slow and gradual. It involves the cutting of bone in two parts, and then the external fixator is attached to the bone, allowing the distraction for lengthening to occur. Distraction can be done a few times per day involving small adjustments, ends at 1mm per day resultant in bone regeneration. The skin, nerve and vessels also lengthen gradually during this procedure. When the bone is fully lengthened, the second operation is performed to remove the external device.

  • Second surgery (optional): Lengthening and nailing (LATN technique)

This second surgery is usually done after your lengthening had been achieved (estimation of 3- 4 months) through mono-lateral fixator.

The LATN technique uses mono-lateral frames for the distraction phase. Pins and wires are placed to allow subsequent intramedullary nailing. At the end of the distraction phase, reamed large- diameter, full-length, statically locked intramedullary nails are inserted and the frames are removed. Contact between external fixation pins and wires and internal fixation must be carefully avoided.

These methods minimizes the treatment time in the external fixator, limited to the time required to obtain the lengthening desired without having to wear the external device during the hardening (allowing the new bone to grow) or consolidation phase. This method also reduces the rehabilitation time, time to return to full weight-bearing activities.

6. What is the postoperative care required for leg lengthening?

In the first 24 to 48 hours, postoperative, pain is controlled by intravenous analgesic. Following that only oral analgesics are required for a few days. Some patients require a one to two-day stay in high dependency to observe for fat embolism.

Distraction is NOT painful and no analgesic is required. The patient is taught to perform bone distraction 3 times a day using a simple portable radio control device.

The stitches are removed on the 10th postoperative day. Patient will require use of crutches for up to 9 months till the bone consolidates.

Physiotherapy to the knees and ankles commences immediately, post-operatively to prevent knee and ankle contractures.

For unilateral lengthening, crutches can be used for mobility with the opposite leg for weight bearing. For bilateral lengthening, a wheel chair is required for mobilization until bone consolidates in 6 to 9 months.

7. What are the potential benefits and risks of cosmetic leg lengthening?

Leg lengthening and reconstruction has been performed using the Ilizarov techniques for many years with good results. The fully implantable nail has significantly lower complication rate and has been used for cosmetic leg lengthening. The maximum leg lengthening possible is 8cm for the femur and 8cm for the tibia respectively. Body image is improved. Males usually prefer thigh lengthening versus female who prefer lower leg lengthening.

Potential complication includes knee or ankle stiffness which requires intensive physiotherapy. Most improve after lengthening although some patients may have some difficulty squatting. Other complications include infection (1-2%), nerve injury (3-5%), mal-union, delayed union especially in tibia (30-40% patients need a minor bone grafting procedure 4 months later), implant failure (failure to distract to full length which is uncommon and may need exchange nailing).

General complications include death (<1%), fat embolism, heart attack, chest infection, blood clot in legs. Of this the only significant complication is fat embolism which is uncommon if done by experienced surgeon and easily treatable with oxygen therapy.

leg lengthening

8. What is the quality of the “new” bone?

The new bone regeneratedd is normal and allows full bearing after 9 to 12 months depending on distraction length. It is good as normal bone and patient can return to sports after 18 months.

9. Is removing the implants required for leg lengthening?

Removal of the nail is not mandatory. This can be easily removed under general anesthesia 2 years after the bone lengthening.

10. How much height can be gained from leg lengthening?

For the internal method, the total estimated achievable height gained is approximately 10-16cm. This consists of thigh bone (femur) ranging from 5-8cm while for the lower leg (tibia) being 5-8cm.

For the external method, thigh bone (femur) lengthening can range from 5-8cm using the monolateral fixator. LATN technique is only possible for shin bones (tibia) lengthening between 5-8cm.

11. What is the required length of stay in Singapore for leg lengthening?

The hospital will assist you to obtain hotel and service apartments at corporate rates. There are wheelchairs friendly with clean rooms & shower facilities. Internet facilities are also provided.

You can return to your home country after 3 to 4 weeks with the internal method and after 1 to 2 weeks with the external method if follow-ups of X-rays at clinic confirm good distraction of the bones.

Every month you need to send X-rays to surgeon and ensure that you see a physiotherapy prevention of joint contractures.

12. What is the recovery period after the leg lengthening procedure?

a. Internal method: ISKD

For leg lengthening surgery, the length of stay in the hospital is about 5-7 days. Generally, patients will require 3-4 months in wheelchairs and another 3-4 months in elbow crutches with partial weight bearing (post surgery).

It can take up to 9-12 months for the bone to heal, walking unaided about 12 months and 18 months before patient can return to sports.

b. External method:

  • First surgery: Leg lengthening surgery using monolateral fixator

For this surgery, the hospital length of stay is about 4-5 days and generally, patients will require 3 months in wheelchair and another three months in elbow crutches with partial weight bearing (post surgery). It can take up to 6 months for the bone to heal, walking unaided about 9 months and 18 months before patient can return to sports.

  • Second surgery (optional): Lenghtening and nailing (LATN technique)

For this surgery, the hospital length of stay is about 4-5 days and generally three months in elbow crutches with partial weight bearing (post surgery). It can take up to 6 months for the bone to heal, walking unaided about 9 months and 18 months before patient can return to sports.

13. Does much does the leg lengthening procedure cost?

a. Internal method: ISKD

The cost of a leg lengthening surgery with ISKD is approximately USD 60,000, including:

– ISKD Implant (2 nails): USD 27,000

– Hospitalization charges (inclusive of surgeon and anesthetist’s fee, medication, operating theater, hospital stay in a 4 bedded-room): USD 32,000

– Outpatient charges (follow-up review, x-rays, medication and rehab): USD 500-1,000.

b. External method:

  • First surgery: Leg lengthening surgery using monolateral fixator

The cost of leg lengthening surgery using monolateral fixator is approximately USD 34,000, including:

– Implant (2 fixators): USD 13,000

– Hospitalization charges (inclusive of surgeon and anesthetist’s fee, medication, operating theater, hospital stay in a 4 bedded-room): USD 20,000

– Outpatient charges (follow-up review, x-rays, medication and rehab): USD 500-1,000.

  • Second surgery (optional): Lengthening and nailing (LATN technique)

The cost of leg lengthening surgery using LATN technique is approximately USD 25,400, including:

– Implant (2 nails): USD 4,400

– Hospitalization charges (inclusive of surgeon and anesthetist’s fee, medication, operating theater, hospital stay in a 4 bedded-room): USD 20,000

– Outpatient charges (follow-up review, x-rays, medication and rehab): USD 500-1,000.