Limb Lengthening Surgery

By Bahar Ozbal • Medical review by Muharrem Inan, MD on February 08, 2021

What is Limb Lengthening Surgery ? What Is The Price Of Limb Lengthening Surgery? How Is Limb Lengthening Surgery Operated? Treatment And Recovery Process After Limb Lengthening Surgery Is Limb Lengthening Surgery Right For Me? How Does Limb Lengthening Work? How Much Taller Can Limb Lengthening Make You? Which Bones Will Be Lengthened? How Do You Lengthen The Bones And Soft Tissues? What Are The Risks Associated With Limb Lengthening Surgery? How Long Does It Take To Recover From Limb Lengthening Surgery? Can You Walk After Leg Lengthening Surgery? Does Leg Lengthening Surgery Leave Scars? The Advantages Of Limb Lengthening In Turkey The Advantages Of Limb Lengthening In İstanbul Sources

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Uygulama General anesthesia

Recovery Time 4-5 Month

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What is Limb Lengthening Surgery ?

What Is Limb Lengthening Surgery?

Limb lengthening surgery, (surgery to get taller) with more known name leg lengthening surgery or height surgery is a long-termed and hard surgery as well, involving a 6-12 months treatment process.

In limb lengthening surgery of which the first stage is completed under general anesthesia by Orthopedics and Traumatology Doctors, the bone to be lengthened is cut first and an "External Fixator Device" is inserted around the opened bones.

By the help of the External Fixator Device, bone is opened 1 mm daily and a cavity in the bone is provided. Bone cavity opened is filled with bone tissue slowly and new bone formation occurs. External Fixator Device is removed with a small operation after bone hardening.

What Is The Price Of Limb Lengthening Surgery?

Limb Lengthening Surgery is planned exclusive to individuals. Many details such as the technique to be applied, the process of treatment, hospitalization, the doctor selected, the city and district where the operation will be performed are the factors affecting the Limb Lengthening Surgery price.

How Much Is A Limb Lengthening In Turkey?

Limb Lengthening in Turkey is cost-effective and hygienically, a contrast to other countries, $16.000 US Dollar for external fixator, $21.000 US Dollar for LON method, $45.000 US Dollar for intramedullary nail (PRECICE 2), $65.000 US Dollar for Precise Stryde, $14.000 US Dollar for limb shortening, $11.000 US Dollar for Limb Discrepancy, $8.500 US Dollar for Limb Correction Surgery (Bow Legs), $14.500 US Dollar for Limb Shortening Surgery.

How Is Limb Lengthening Surgery Operated?

In cases of dwarfism, the target length is 1.50 cm for females and 1.60 cm for males in limb lengthening surgery. In the case of limb lengthening surgery for aesthetic purposes, the target length is determined according to the request of the person.

Limb Lengthening Surgery is planned exclusive to individuals. The expectation of the person, joint motion gap, the condition of the muscles and the capacity of the bone are considered to be important in this planning.

Limb Lengthening Surgery is operated through 3 methods: Intra-bone, extra-bone and combined system...

The intra-bone method is preferred in aesthetic Limb Lengthening Surgery; while health-based lengthening operations such as dwarfism are performed by the extra-bone method. Ideally accepted Limb Lengthening Surgery method is the one performed both with intra-bone and external-bone interventions, called combined method and surgeries of which the recovery process is more comfortable and faster.

Limb Lengthening Surgeries are operations that last 1-1.5 hours under general anesthesia. Postoperative treatment duration varies depending on the target length and daily rate of lengthening. The expected daily lengthening rate of Limb Lengthening Surgery is 1 mm. This target millimeter can be reduced or increased depending on the quality of bone formation. If an average of 1 mm lengthening per day is assumed, the time to reach a person's target cm is planned based on this target value. In other words, if the person targets for a lengthening of 5 cm, then the treatment process should be planned at least 50 days.

1. Extra-Bone Limb Lengthening Surgery:

In Extra-Bone Limb Lengthening Surgery, bone is bonded to the "External Fixator Device" applied externally. Bone cracking procedure follows this process step.

Surgery is operated under general anesthesia and rarely under local anesthesia.

In Extra-Bone Limb Lengthening Surgery, both legs can be subjected to a lengthening procedure at the same time, so that the treatment process is completed in a shorter time compared to the intra-bone limb lengthening surgery, since both legs will be stretched at the same time.

If Extra-Bone Limb Lengthening Surgery is to be applied for a single leg, duration of hospital stay will be 3-4 days and will be 4-7 days for both legs. Lengthening process starts during hospitalization, then, the duration of treatment is calculated as per the predicted lengthening. After the lengthening process is completed, the strengthening of the bone lengthened (consolidation) and then the removal of the system procedures are performed respectively. The total treatment duration is completed in the range of 6-12 months.

2. Intra-Bone Limb Lengthening Surgery:

In Intra-Bone Limb Lengthening Surgery, the bone is cut from the inside and an intramedullary nail is inserted into the bone, in the second step, the bone attached with the nail is attached to the External Fixator Device. Surgery is operated under general anesthesia.

The person is discharged after 5 days of hospitalization. Lengthening period and rehabilitation time varies according to the lengthening (5 cm. - 50 days). Then, the consolidation period begins, which is an average of 3 months (the period for the new bone formed to be strong after the lengthening is over is called "Consolidation").

In Intra-Bone Limb Lengthening Surgery, lengthening of one leg is completed first, then the other leg is operated.

3. Intra-Extra Bone Combined System Limb Lengthening Surgery:

In Intra-Extra Bone Combined System Limb Lengthening Surgery, lengthening systems are placed both inside and outside the bone. When the lengthening process is over, the system outside the extra-bone system is removed but intra-bone system is not, the person can complete the other stages of the lengthening process with the nail system inside the bone. That is, rehabilitation, consolidation period is maintained by the intra-bone system.

The nails used do not need to be removed; however, a second operation can be planned to remove the nails, in case of request. Combined System Limb Lengthening Surgery allows faster return to daily life compared to other limb lengthening surgeries, and the duration of application is shorter than in single applications.

Treatment And Recovery Process After Limb Lengthening Surgery

Limb Lengthening Surgery consists of 6 processes in total;

● Inspection and examination

● Surgery

● Hospitalization

● Lengthening process

● Strengthening of the bone lengthened (consolidation)

● Removal of the system

Since the period involving the lengthening after the Limb Lengthening Surgery covers 4/6 of this period, a toilsome and tough treatment and healing process await the patients. After the surgery, the physician planned physical therapy and exercises should be done correctly and should not be disturbed so as this is important for both postoperative pain relief and healthy development. Sports and exercises prevent the loss of muscle loss while supporting the period of healthy lengthening.

The lengthening process starts as of the 5th and 7th days after the limb lengthening surgery. 1-mm device setting is required each day, ground on 1 mm lengthening per day.

Routine checks are performed at the 1st, 2nd and 3rd weeks with the start of the lengthening process. Bone lengthening is checked in these controls. After reaching the target lengthening rate, "consolidation" period begins. This period is the process for the new bone formed to strengthen after the lengthening is over. It lasts an average of 3 months.

Finally, the treatment and healing process is completed by removing the systems inside and outside the leg.

Is Limb Lengthening Surgery Right For Me?

Lower age limit for Limb Lengthening Surgery is set as 3 years of age. For children who are below the percentile value in the age group and who cannot catch their peers in height, Limb Lengthening surgery can be planned from the age of 3 years.

Although there is no upper age limit for Limb Lengthening Surgery, the age range of 40 years and older is not recommended for Limb Lengthening Surgery since the quality of bone development has decreased.

Anybody who thinks that his/her height is short or has been approved in medical terms with short stature in a doctor's report, any man and woman in the appropriate age range are suitable candidates for Limb Lengthening Surgery.

It is important that the people who are planned for Limb Lengthening Surgery should be healthy, non-smokers and those who are in realistic expectations from the lengthening operation, who are aware of the risks and problems of the operation.

Patient expectation, joint motion gap, muscle status, and bone capacity determine whether a person is an appropriate candidate for limb lengthening surgery.

Is Limb Lengthening Surgery A Painful Operation?

Limb Lengthening Surgery involves a painful operation and treatment process. The person will have severe postoperative pain. Post-operative pain is at a level that can be relieved by the pain relievers recommended by your doctor.

The reduction of pain in the course of treatment is only possible by regular physical therapy and exercises recommended by the doctor. Bones and muscle tissue strengthened by exercises help to reduce pain.

How Does Limb Lengthening Work?

The limb lengthening surgery is based on a process by separating the bone, to provide gradually growing new bone and soft tissues such as skin, muscle, nerves, blood vessels, etc. Lengthening works by regenerating bone and soft tissue approximately 1 mm per day.

There are two phases of lengthening works: distraction phase and consolidation phase. Lengthening phase is called distraction; the hardening and calcification of the new bone is called the consolidation phase. As a result, a user who gets this surgery visualizes an increased length.

How Much Taller Can Limb Lengthening Make You?

Height surgery provides height gain is accomplished by lengthening both the femurs (about 8 cm for the femurs) and tibia (about 6.5 cm for the tibia). Limb lengthening procedures involve height gain of approximately between 7,5 cm - 14.5 cm.

Which Bones Will Be Lengthened?

Limb lengthening is a procedure to lengthen the bones in the arms or legs. The bones that will be lengthened are; humerus (upper arm bone), radius/ulna (forearm), femur (thigh bone), tibia (shin bone) and metatarsals (bones in the foot that affect toe length). The procedure can also perform with one or two different types of bones at one time.

How Do You Lengthen The Bones And Soft Tissues?

For lengthening and deformity correction, the bone is usually cut through a 1-cm (<0.5-inch) incision to minimize injury to tissue. Rehabilitation starts the day after surgery. Extra-bone system and/or intra-bone system is inserted into the marrow of the bone and is fixed to the upper and lower part of the bone with screws. Lengthening usually begins a few days or a week after surgery (latency period). The lengthening rate is usually planned as 1 mm per day but may be slower or faster depending on the tolerance of the bone and soft tissues to the distraction process. As the extra bone or/and intra bone system activated, the telescopic rod lengthens, which lengthens the bone and soft tissues.

During the distraction phase physical therapy is required. Physical therapy is designed to stretch muscles. This will help the muscles grow and maintain joint flexibility.

What Kind of Leg Lengthening Surgery Methods Exist?

LON, Holyfix, Ilizarov, STRYDE and PRECICE 2 are the names of the methods used to lengthen the bones in the arms or legs.

“LON Method" -lengthening over nails-, means that the bones are distracted or lengthened with an internal nail. In Lon Method the bones are lengthened using a mono-lateral type external fixator device.

LON Method allows external devices to be removed in and around 3-4 months after surgery. The intramedullary nails stay inside for about 1-1.5 years time after surgery till the bones fully consolidate, heal, and recovery.

STRYDE and PRECICE 2: “STRYDE” is the newer version of “PRECICE 2 Method" and is the latest limb lengthening system. In theory both systems are nearly the same but the Stryde Method comes with many innovations and benefits for patient comfort. Stryde and PRECICE 2 methods both used in Intra-Bone Limb Lengthening Surgery where internal intramedullary nails internally embedded into bone. both PRECICE STRYDE ”&“ PRECICE 2 ”systems are much less painful, in comparison to the methods (LON, Holyfix and Ilizarov ) employing external fixators.

“Holyfix” is a method used Extra-Bone Limb Lengthening Surgery. In the Holyfix method, monolateral external fixators are attached by pins to the nearest and safest area, especially not near any vein and nerve.

The Holyfix apparatus is perfectly designed to allow accelerated bone formation and transfers the burden from the bone without any shortening. The external fixator device used in the Holyfix method is similar to the one used in the LON method. The main difference between LON method and Holyfix is the internal intramedullary nails which the bones are lengthened over.

The Ilizarov method is the first methodology for bone lengthening. Ilizarov method is used in the Extra-Bone Limb Lengthening Surgery. The procedure is performed by fixing the bone with thin wires and circular external fixator devices. These wires and the device itself holds the bone in place and prevents rotation and misalignment.

What Are The Risks Associated With Limb Lengthening Surgery?

Many potential risks are associated with limb lengthening surgery. These risks are associated unlikely in most cases, but, should they occur, they can be corrected by surgery.

● Limb Lengthening Surgery may cause damage and adverse effect on neurovascular structures.

● The bone might nonunion,

● Leg length discrepancy,

● Nerve stretch injury,

● Muscle/tendon contracture leading to stiff joints and Joint arthritis,

● Deep vein thrombosis,

● Fat embolism.

● Pain, bleeding that can result in Haematoma or compartment syndrome and may occur deep vein thrombosis and pulmonary embolism, and nerve injury as a result of stretching.

● Pin site infection is another rare but common complication of Limb Lengthening Surgery

● Intolerable pain post leg lengthening surgery is too much to cope up with.

● Bedridden for 3 months creates an emotional setback for the patients.

In rare cases,

● The bone might fail to heal completely and bone graft surgery might be required.

● A nerve may become too stretched, which occasionally requires surgery to decompress the nerve.

● Tight muscles and tendons might require tendon-lengthening surgery.

● Lengthening that occurs too slowly or failure can lead to premature bone healing. Your surgeon may need to re-cut the bone to allow the lengthening process to continue.

How Long Does It Take To Recover From Limb Lengthening Surgery?

Recovering from limb lengthening changes due to the type of surgery. It's important to know that in any case besides the methods chosen there will be a lengthy period of recovery, called the “consolidation phase”.

Also age factor is an important criterion that shapes the recovery time. While children are required to wear a leg lengthening device for around three months, adults need to wear one for about six months.

Limb lengthening recovery time comes with steps.

The first step is "Distraction Phase". Lengthening usually begins a few days or a week after surgery. Physical therapy is required on an outpatient basis in all cases during the distraction phase. During the distraction phase, patients need to be examined and x-rays obtained every 2 to 3 weeks. This will help to prevent complications from occurring, to see how the evaluation of the bone growth is going, how the nerve and muscle function works.

The total average of external fixation treatment time for children is 1 month per centimeter and for adults can be as long as 2 months per centimeter.

The external fixator can be removed when the bone is supported from the inside by the rod. Therefore, the external fixator is in place only for the distraction phase.

The second step is the "Consolidation Phase". It starts after the desired lengthening or deformity correction has been achieved. In this phase all adjustments to the lengthening device cease. The consolidation occurs with the rod alone.

X-rays must be obtained approximately once per month to evaluate bone healing during Limb lengthening recovery time.

The third step is called "dynamization". As long as the bone looks sufficiently healed and will not collapse, your surgeon will remove the external fixator rods. This will help to reduce the tension on the bone. Usually the external fixator is removed one month after dynamization.

The last step of Limb lengthening recovery is: Removal of the External Fixator

This phase will be done mostly under anesthesia, rarely patient awake. After removal, many patients require a cast for a month of additional protection.

Whole of the procedure is completed in 1-1,5 year time.

Can You Walk After Leg Lengthening Surgery?

To walk after leg lengthening surgery takes a time. While some people can walk without any support after the first week, mostly, they can walk by walker for the first 2-3 months. How long will it take to walk after leg lengthening surgery can change from person to person. To shorten the time it's important to pay attention to your physiotherapy after the surgery.

Does Leg Lengthening Surgery Leave Scars?

Leg-lengthening surgery is provided with minimally invasive surgery which causes a lot less scarring after recovery. So as a short answer we can say that; Yes! leg lengthening surgery leaves scars.

The Advantages Of Limb Lengthening In Turkey

Limb lengthening surgery in Turkey is a common procedure that is performed for the treatment of dwarfism and the post traumatic femoral shortening.

There are different methods used in limb lengthening surgery. In limb lengthening surgery Turkey; LON, Holyfix, Ilizarov, STRYDE and PRECICE 2 methods are used to lengthen the bones in the arms or legs.

The most advantageous part of having your Limb Lengthening surgery in Turkey is; in some cases Turkey can provide treatment only using an intramedullary rod without any external apparatus.

Limb Lengthening surgery costs in Turkey, includes a hospital stay of about 5-6 days, clinical and radiographic checks at a rate of about 30 days. You will be given an all inclusive package price list before you arrive for the surgery.

The Advantages Of Limb Lengthening In İstanbul

With the number of health care institutions accredited for quality of patient care and organization management İstanbul is the capital city of Europe in health tourism.

The Advantages of Limb Lengthening in İstanbul can be summarized as;

● İstanbul has an affordable healthcare system and has the highest number of US-accredited hospitals,

● You can find experienced Limb Lengthening surgeons in İstanbul who have trained in Europe and America and choose to practice in Turkey,

● Istanbul Airport, in Turkey, is also considered as one of the world’s largest airports with around 200 million passengers each year and has around 300 direct flights worldwide.

● Limb Lengthening surgery in İstanbul is also 70 per cent cheaper than most of Europe. So you can achieve more affordable treatment without sacrificing the quality of service.

● You can get a Limb Lengthening procedure scheduled in as early as two weeks compared to waiting for almost 18 months for some procedures in the other countries.