How Soon After Limb Lengthening Surgery Can I Walk?

Are you considering limb lengthening surgery and are eager to get back on your feet and test out your enhanced legs? Though the surgery involves literally breaking the femur and tibia bones, modern innovations allow patients to walk from day one after surgery. However, other methods might have you wheelchair-bound for months. Read on to find out how soon you can walk, run, and play sports again with the various nails or methods.

Timeline to Walk After Height Surgery

How soon you begin walking after height surgery depends on the method or nailing technique used, in addition to how fast your bones heal (consolidate). Internal nail methods facilitate faster consolidation of bone. They’re the best choice if you want to resume physical activity soon after your surgery.

Walking With STRYDE

Since the STRYDE nail is full weight-bearing, it’s the most convenient option if you want to retain mobility and recover as quickly as possible. Believe it or not, many patients start walking with the help of crutches or a walker the day they get out of surgery! However, you might have to use a wheelchair if you’re traveling long distances.

For STRYDE and other intramedullary procedures, a general rule of thumb applies:

• Femur – 1 week of healing for every 1 cm increase in length
• Tibia – 1.5 weeks of healing for every 1 cm increase in length[1]

Since patients with STRYDE generally lengthen 0.75 mm to 1 mm a day, the distraction phase can last anywhere from 2-4 months to a year depending on your goal height.[2] For an 8 cm increase in femur length, the distraction period would be 12 weeks, and healing would be complete in about eight weeks.

The STRYDE has been recalled from US and UK markets, but is expected to be back by January 2022. [3]

Walking With PRECICE

PRECICE, especially PRECICE 2.2, is an exceptionally popular procedure as it’s less expensive than STRYDE, but still the second-best nail or method to date. The trade-off, however, is that it won’t be able to bear weight at any point during the distraction phase. Which in turn, makes the recovery period much longer due to atrophy (the degradation of muscle).

With PRECICE 2.2, you have to use a wheelchair while lengthening and crutches late into the healing phase, but you certainly won’t be bedridden.

PRECICE 2.2 patients start walking about 3-4 months after the original surgery (not during the distraction phase). You would need to use a walker or crutches for the first 1-1.5 months, but you should be able to work your way up to walking unassisted after that time.

Walking With LON

Lengthening Over Nail (LON) makes use of an intramedullary (internal) nail, similar to STRYDE, but also uses an external fixator device controls the lengthening of the nail. Since it utilizes a non-weight-bearing nail, it’s possible to walk during the entire lengthening period, although you may have to use crutches for stairs or a wheelchair over long distances.

LON is much more affordable than STRYDE and PRECICE – and you can walk, but you have to deal with the discomfort the bulky external fixator brings.

This lasts for 2-3 months at a rate of 1 mm a day. Once 2-4 weeks’ worth of bone consolidation is visible, the eternal fixators are removed, and you can walk more easily.

Walking With Other Nails & Methods

Other than the above methods, Lengthening And Then Nailing (LATN) is also available. In this method, external fixators are installed during the first surgery. Once the distraction phase is complete, a nail is inserted into the bone marrow. A couple of weeks after the lengthening phase, you can start using crutches to walk.

There’s also the Ilizarov method, which is the oldest amongst all height surgeries. You’ll be able to walk with crutches, but the external fixator will have to be worn for a longer time than LON, and recovery will be slower.

The Ilizarov method is much slower than all others – after a 3-4 month consolidation period, it takes 45 days to heal for every 1 cm increase in length. Since the external fixator has to be worn until bone consolidation is complete, walking can be uncomfortable for quite some time.

There are many other methods of nails or methods on the market, and these are only some of the most commonly used nails today.

Tips for Walking After Limb Lengthening

If you graduate from walkers to crutches to canes too fast, you’re likely to develop a poor gait, limp, or even an anterior pelvic tilt (APT). To avoid these problems and steer clear of building poor muscle memory or recruitment patterns, you can follow some basic tips:

• Attend physical therapy regularly – foregoing PT will leave you tight, sore, and walking oddly
• Use a walker from the beginning of the distraction period if possible, but train yourself to put less and less weight on it until you can walk with proper form.
• Practice dorsiflexion (raising toes upwards) by stretching the muscles in your calves and the back of your legs, especially the hamstrings. Besides these, stretching your glutes and your hip abductors will also help in holding your legs straight.

As always, go into the surgery with a positive attitude and an open mind, but make sure always to take your doctor’s advice. Keep up with stretches, exercises and if possible, and walk as much, or as soon as possible after surgery for a quick and successful recovery.

References

[1] Cyborg 4 Life. (2020, May 5). How long does it take to walk after limb lengthening surgery [Video]. https://www.youtube.com/watch?v=KEtJYeQOcn8

[2] Robbins, C., & Paley, D. (2020, September). Stryde Weight-bearing Internal Lengthening Nail. Techniques in Orthopaedics, 35(3), 201-208. https://paleyinstitute.org/wp-content/uploads/Stryde-Weight-bearing-Internal-Lengthening-Nail.pdf

[3] NuVasive. (2021, February 20). URGENT RECALL NOTIFICATION PRECICE STRYDE, PRECICE PLATE AND PRECICE BONE TRANSPORT. NuVasive. https://www.nuvasive.com/wp-content/uploads/2021/02/NSO-Precice-FSN-United-States-Biodur.pdf