Common Questions About Limb Lengthening Surgery: Procedure, Recovery & Risks

There are many reasons a patient might be considering leg/limb lengthening surgery.

They may have a medical reason, such as congenital limb difference, skeletal dysplasia, amniotic band syndrome, or bone tumors. Maybe they have suffered an injury or trauma to their limbs, which has resulted in unhealed fractures or growth plate fractures. Perhaps they are a parent whose child has limb length discrepancies, or an athlete who has suffered an injury and is looking to get back in the game.

Whatever the reason, leg/limb lengthening surgery is a highly specialized procedure that should be addressed with the utmost consideration and care. Leg/limb lengthening surgery can help correct limp discrepancies and improve mobility, but it requires the experience and expertise of a highly trained and skilled surgeon, with the support of a compassionate and capable surgical staff.

That’s where we come in.

At the Orthopedic Institute of North Texas, we have performed numerous orthopedic surgical procedures, including leg/limb lengthening surgery, and have answers to the questions you’re probably asking, such as:

1. Is leg/limb lengthening surgery safe?
2. Does leg/limb lengthening surgery work?
3. Is leg/limb lengthening surgery worth it?
4. What are the side effects and recovery timelines for leg/limb lengthening surgery?

Let’s tackle these questions, and more, so you can make the most informed decision regarding your potential leg/limb lengthening surgery.

Here are 10 most common questions about leg/limb lengthening surgery.

1. What is leg length discrepancy (LLD)?

Let’s start here: What is leg/limb lengthening surgery?

It is one of two surgical procedures used to correct limb lengthening discrepancy, or LLD for short. Simply put, LLD is when one leg is longer than the other. It’s also quite common. According to Physiopedia, up to 35% of adults have a leg length discrepancy of 0.5 or 1.5 centimeters, a little less than an inch.

Minor discrepancies oftentimes go unnoticed and don’t require treatment. However, larger discrepancies are not only visible, they can also affect mobility, cause pain, and lead to hip, lower back, and other orthopedic problems down the road.

In other words, LLD should never be taken lightly.

2. What causes leg length discrepancy?

There are seven common causes of leg length discrepancies.

1. Trauma: Fractures that occur through the growth plate or have overriding ends that do not properly heal can disrupt limb growth and healing.
2. Joint replacements: Hip or knee replacement surgery sometimes results in changes in leg length that may require surgical correction.
3. Degenerative conditions: Certain conditions can cause LLD, including:
   • Legg-Calvé-Perthes disease (LCPD), a childhood hip condition where the blood supply to the femur is temporarily interrupted.
   • Slipped capital femoral epiphysis (SCFE), a condition usually affecting children and teens, where the femur slips off the neck of the bone at the growth plate in the hip.
4. Bone infections: Severe skeletal infections can affect bone integrity and cause LLDs, such as osteomyelitis.
5. Neurological conditions: Conditions like polio or never injuries/issues can cause LLDs.
6. Bone loss: The loss of bones from tumors, trauma, or infection can lead to LLDs.
7. Untreated development discrepancies: LLDs from any of the above causes that weren't properly addressed during developmental years can become exacerbated over time, leading to problems.

3. How is leg length discrepancy diagnosed?

At the Orthopedic Institute of North Texas, we use a variety of techniques to properly diagnose and treat LLD, including:

• Clinical assessment: Your orthopedic surgeon will evaluate your posture, gait, and functional limitations. Your surgeon may also watch you walk to look for signs that you are compensating for different leg lengths, or ask you to stand with a block under your shorter leg to measure the amount of correction needed.
• Imaging: To ensure the most accurate view of the LLD, the surgeon will order X-ray imaging of the entire lower extremity. Your surgeon may also order a CT scan for complex cases, such as if there are contractures (shortening and hardening of muscles, tendons, or other tissue).

4. What symptoms indicate a leg length discrepancy needs treatment?

As we noted above, LLDs are common, with more than a third of the population having some form of LLD. However, if one leg is more than 10-mm shorter than the other, it creates problems that demand treatment.

Here are the signs and symptoms your LLD requires treatment:

• Pain: LLDs can cause asymmetry in the body that can cause lower back pain, hip pain, and other painful problems.
• Gait abnormalities: Limping or walking unevenly is a sign of a severe LLD. This can also cause fatigue, as you're working harder to walk.
• Daily disruptions: Having an LLD can cause great difficulty with everyday activities, including exercise. If you’re unable to comfortably exercise or even move it can even put you on the road to serious physical and cardiovascular problems.
• Secondary conditions: LLDs can lead to arthritis, knee pain, and functional scoliosis.

5. What non-surgical treatments are available for leg length discrepancy?

Not every LLD requires surgical treatment. For mild-to-moderate discrepancies (2 cm to 2.5 cm), we provide the following non-surgical treatment options:

• Shoe modifications: We can provide a heel lift or other shoe insert that can easily even out leg lengths with minimal disruption.
• Custom orthotics: We can design specifically calibrated insoles to address the LLD, and any walking issues it causes.
• Physical therapy: We provide specialized physical therapy services that are focused on addressing muscle imbalances, gait training, and core strengthening.
• Pain management: We can prescribe medication or provide injections to help you deal with any pain associated with LLDs.

6. When is surgery recommended for leg length discrepancy?

We will recommend surgery for LLDs based on the following:

• Major discrepancy: We will address moderate cases (30-60mm) on a case by case, and may require surgery. However, severe cases (more than 60mm) should be corrected surgically.
• Failed non-surgical treatments: We will recommend surgery if pain or other issues continue despite non-surgical treatment:
• Daily disruptions: If your day-to-day life is severely disrupted by LLDs, surgery is strongly recommended.
• Progressive problems: We recommended surgery for LLD if you suffer from secondary issues, like scoliosis or joint problems.

7. What are my surgical options for leg length discrepancy?

At the Orthopedic Institute of North Texas, we offer the following surgical procedures for LLDs.

1. Leg/Limb shortening: For smaller discrepancies, the recommended surgery is leg shortening, where the surgeon removes a small section of bone from the longer leg.
2. Leg/Limb lengthening: For greater discrepancies, we recommend leg/limb lengthening surgery. In this procedure, the surgeon will cut the bone of the shorter leg into two segments, then surgically apply an external fixator or internal lengthening device. As the device gradually expands, new bone will grow and fill in the space it creates.

The leg lengthening process begins between five and ten days after surgery. The bone typically lengthens 1 mm per day, or up to 1 inch per month.

There are two main approaches for limb lengthening surgery:

1. External fixation: The surgeon uses a frame outside the body connected to the bone with pins.
2. Internal lengthening: The surgeon implants an expandable rod in the bone. An external remote control controls magnetic gears inside the rod, gradually expanding the rod, and pushing the bone segments apart.

As with any surgery, there are risks to either treatment option, which include: infections, joint stiffness, muscle contractions, nerve or blood vessel injury, delayed bone healing, hardware issues, or premature consolidation (i.e. bone heals too quickly).

Because of these potential complications, experience is extremely important. An experienced orthopedic surgeon, supported by a trained support staff, will not only successfully perform the procedure, but also help prevent any issues.

9. What is the recovery process like after leg/limb lengthening surgery?

The recovery for leg/limb lengthening surgery starts with a hospital stay between two and five days. Following this, there are two phases:

1. Distraction phase: The gradual-lengthening period, which lasts weeks to months depending on the amount of lengthening needed. During the lengthening phase, we require regular physical therapy, as bone lengthening requires adjustments and exercises that your physical therapist can help guide you through.
2. Consolidation phase: Once the desired length has been achieved, you will enter the consolidation phase, where the bone begins healing.

10. What results can be expected from limb lengthening surgery?

Now that we have shown that leg/limb lengthening surgery is safe, and discussed what you can expect, let’s go back to two of the other questions we asked at the beginning:

1. Does leg or limb lengthening surgery work?
2. Is leg or limb surgery worth it?

For people with mild limb length differences, there is generally no major effect on health or activities. However, if limb length differences remain untreated, you may develop back and hip problems. Therefore, surgical treatment is an excellent preventative measure. Additionally, it will help eliminate LLD from becoming more severe.

For more severe LLDs, surgery is required, and can provide the following benefits:

• Equalizing limb lengths
• Improving gait and function
• Alleviating pain
• Preventing secondary issues, like scoliosis or joint problems
• Enhancing quality of life

Every patient is different, so to get a better idea of how surgical or non-surgical treatment options may benefit you, we recommend talking one on one with your surgeon.

Why should I choose Orthopedic Institute of North Texas for my LLD treatment?

So why us? Whether you require non-surgical treatment or surgical treatment for LLD, the team at Orthopedic Institute of North Texas provides the experience, expertise, and proven multidisciplinary approach you need:

• Highly skilled, trained, and experienced orthopedic surgeons who have performed numerous leg/limb lengthening procedures.
• State-of-the-art technology and techniques to diagnose and treat your LLD.
• Comprehensive, pre-operative planning between our team members, with consistent communication so you know exactly what to expect and when.
• Specialized physical therapy, helping to make sure you achieve the best possible outcomes.
• Patient-centered approach, with a personalized treatment plan tailored to your specific condition, activity level, and goals.

If you suffer from leg length discrepancy, see how we can help relieve pain, restore mobility, and improve your quality of life, just like we have hundreds of satisfied orthopedic patients.

Improving your LLD, and your life, starts with taking the first step.With multiple convenient locations, around the North Texas area, schedule an appointment with OINT today.