Leg lengthening surgery is the only permanent fix for legs of unequal length. It is also increasingly being used as a cosmetic procedure to become taller.
Do you need to have leg lengthening surgery?
If your legs are of uneven length:
If the difference in length between the two legs is more than 1 inch and if the discrepancy is due to developmental problems, then you may need leg lengthening surgery to resolve this discrepancy, especially if the unevenness is hampering your ability to walk normally.
If you want to be taller:
Leg lengthening is now commonly performed for cosmetic purposes in those who are of short stature. The surgery can safely increase the length of the legs by 2.0 to 2.5 inches and even up to 4.0 inches in certain extreme cases.
How is a leg lengthening surgery performed?
Leg lengthening surgery involves an osteotomy (surgical cut of bone) and is, therefore, typically performed by an orthopedic surgeon. The surgery is performed under general anesthesia. The procedure involves separating the bones of the legs and pulling the bone segments apart gradually over time through a frame called a fixator which contains 2 rings connected by extendable rods and wires and screws to connect the rings with the bone. These rods in the fixator can be lengthened using adjustable bars called struts, thus increasing the gaps between the bone segments.
The gaps thus created between the bone segments causes bone formation or regeneration in order to fill the gaps, leading to a gradual lengthening of the leg bones, in the process.
Prior to the surgery, a screening of the leg is performed to design the external fixator. During the surgery, the fixator is fixed to the leg bones by metal pins and screws which are inserted through the skin.
The struts need to be turned several times per day to extend the rods and, thereby, increase the gaps between the bone segments in the leg.
Lengthening begins in the first few days, but the frame will be required till the new bone forms to fill in the gap. The fixator is lengthened in two-millimeter increments.
The bone lengthening period typically lasts three months and is followed by a bone strengthening period of around six to eight months, depending on the patient’s physical stature and strength. When the desired length of the leg is achieved another surgical procedure is required to remove the implanted metal device.
Over time, the leg can be lengthened by as much as 2 to 2.5 inches, even reaching 4 inches in some cases.
How do you evaluate your candidacy for leg lengthening surgery?
- A physical examination is conducted to assess pelvic obliquity, size of foot and knees, angular deformity and overall discrepancies of the legs
- Precision measurements are made to detect the leg length discrepancy
- Series of x rays are done to evaluate the effected leg that are repeated at intervals of 6 to 12 months to observe the growth pattern of the legs which can help in treatment plan
- CT scans are helpful to measure the accurate amount of discrepancy
What are the risks of a leg lengthening surgical procedure?
Possible complications associated with leg lengthening surgery include:
- Blood clots
- Injury to Nerve and blood vessels
- Osteomyelitis (bone infection)
- Contractures (joint stiffness)
- Dislocation of joints
- Refracture of bones
- Unequal leg length
- Destruction of cartilage
- Loosening and infections of pins or wires
What are the phases after leg lengthening surgery?
There is a latency period immediately following the surgery and before the actual lengthening of the leg. During this period callus bone regenerates in the gap which was formed by pulling apart of bones during surgery. Patients are required to turn the rods of the external fixator four times per day. This is followed by the distraction phase and the consolidation phase as discussed below.
The lengthening of the bone period also known as distraction phase is the actual phase in which the lengthening is achieved through the fixator. The duration of the lengthening process can be longer in adults than in children because the healing process typically takes half the time in children. Physical therapy is necessary for the lengthening process and recovery starts approximately in a week after surgery. The rate of lengthening of the bone is approximately 1 mm per day and this phase is concluded once the patient achieves the desired leg length.
Fixators will remain in place throughout this phase without further adjustments until the new bone becomes harder. It is followed by physical therapy. Healing of the bone can be checked through x rays which can be done monthly.
Guidelines to follow during the healing period following leg lengthening surgery
After the leg lengthening surgery, you are advised to follow certain guidelines and precautions as advised by the surgeon and typically include the following:
You will be hospitalized for a period of one to two weeks after the surgery for intensive physical therapy
Care of the lengthened leg:
You should not put weight on the leg for a few months. Intensive care is needed to prevent infections including cleaning of the skin around the pins that attach the external fixator. Frequent visits to the doctor to adjust the external fixator are necessary.
Regular therapies and exercises:
Physical therapy, stretching and strengthening exercises should be done on a regular basis to maintain flexibility of the leg joints. Aquatic therapy (immersion in a pool) can also help recover faster.
Medications and diet:
The surgeon will typically prescribe medications for managing pain or muscle spasms and you should eat a balanced and nutritious diet to promote quicker healing and recovery. Calcium supplements are also usually advised to facilitate bone growth.
After six to eight weeks from the date of the surgery, you will be advised to proactively move around with the help of walkers and crutches. Moving up and down stairs will also help exercise the joints.
If you follow the aftercare instructions diligently and follow-up with your surgeon on a regular basis, you can get back to your regular day-to-day activities in about six to nine months from the surgery.