Is Limb Lengthening Surgery Dangerous?

Limb lengthening surgery may sound scary since it’s literally the process of increasing a person’s height by slowly separating the femur (thigh) or tibia (calf) bones. Since it’s a pretty invasive surgery, many people wonder, “Is limb lengthening surgery dangerous?”

The success rate of height surgery is very high or about 95%, but it does come with risks [1].

How Dangerous is Limb Lengthening Surgery? (Risks & Concerns)

Many people think limb lengthening surgery is dangerous since it’s a time-intensive and laborious effort, causing rightful concerns about the risk of long-term complications when they hear about this surgery. 

Despite being largely safe, it can become dangerous if potential patients don’t keep the three safety points in mind (we’ll discuss these three safety tips below). However, it’s necessary to know the possible complications of limb lengthening to mitigate risk.

Potential Risks of Limb Lengthening Surgery

Limb lengthening patients invariably experience at least some complications, but most of them are easily treatable with physical therapy or minor surgery and don’t turn into long-term problems. 

Some of these common side effects and risks of of leg lengthening include:

• Soft Tissue Pain and Stiffness: Since the bones stretch apart, the soft tissues need to extend with them. This force on the muscles can lead to pain and stiffness.
• Muscle Weakness: The excess force on muscles and lack of physical activity can cause them to become permanently weak.
• Nerve Pain: Nerves can become overstretched, leading to sharp nerve pain.
• Insomnia: Patients may be unable to fall or stay asleep due to pain.
• Concentration Issues: Patients may be unable to concentrate because of constant dull pain and narcotic medication.
• Joint Contractures: These occur when patients can’t move the knees, hips, or ankles through their full range of motion due to muscle stiffness.

However, it isn’t the minor complications that make patients wonder if limb lengthening surgery is dangerous. While these complications are easily fixable, some problems can turn into long-term issues and even become life-threatening. Although these types of issues are much rarer than those mentioned above. 

More serious complications include, but are not limited to:

• Nerve Injury: Excess pressure on the nerves, especially the peroneal nerve on the top of the foot, can cause intense pain and long-term issues if not fixed through surgery.
• Drop Foot: People with damage to their peroneal nerve can’t flex their feet upwards, developing drop foot. 
• Malunions and Non-Unions: When the two segments of bone fail to join or heal improperly, it causes a malunion or non-union, increasing fracture risk.
• Premature Consolidation: This condition occurs when the bone segments heal and join before the lengthening period is complete. Although the risk of this procedure is only about 1%, patients must undergo another surgery to break the bone if it occurs [2].
• Fat Embolism: Fat embolism, while extremely rare, is one of the worst risks associated with leg lengthening. As the bone marrow compresses due to the nail inserted into the bone, it can make its way into the bloodstream, and if it reaches the lungs, it can cause a fat embolism. This complication can be fatal if not diagnosed in time. 
• Deep Vein Thrombosis: Due to damage during surgery, a blood clot can form, leading to high blood pressure and swelling. 
• Pulmonary Embolism: If the blood clot formed by deep vein thrombosis reaches the lungs, it causes a pulmonary embolism, which is possibly fatal. 
• Bowlegs: If the femur or the tibia become misaligned outwards during the distraction phase, it can lead to bowlegs, i.e., the knees bending outwards away from each other. 
• Knock Knees: If the femur or the tibia becomes misaligned inwards during lengthening, it causes knock knees, i.e., the knees bending inwards and preventing the patient from putting their feet together. This condition is much more likely during tibia lengthening. 
• Fibular Problems: When lengthening the tibia, the fibula (the thin bone running along the tibia) must be screwed to the calf bone so when one extends, the other follows. If the fibula attaches to the tibia improperly, it can consolidate early and dislocate or remain shorter than the tibia, leading to ankle arthritis and knee contractures.

While these risks are real, keep in mind these conditions are exceedingly rare and less likely to occur with an experienced surgeon and proper post-surgical care. 

How Safe is Limb Lengthening Surgery? (Success Rates & Facts)

Limb lengthening is pretty safe – as mentioned before, leg lengthening success rates are very high at 95%, and a high rate of patient satisfaction and improvement in self-confidence [1][3]. Even with the Ilizarov, the rate of complications is 37%, the vast majority of which surgeons resolve before the lengthening process is complete [4]. 

Only 5-6% of complications require unplanned surgery, like knock knees [5].

External fixation devices like the Ilizarov have a higher chance of causing infections, soft tissue scars, and muscle tethering. Therefore, using modern intramedullary nails like the PRECICE 2.2 or the PRECICE STRYDE is significantly safer these days. 

With the PRECICE nail, patients haven’t reported any cases of permanent nerve damage or infections to date. The STRYDE also has a 100% success rate with careful pre-operative planning and proper post-operative protocols, along with a very slight risk of developing knock knees or bowlegs [6]. 

These facts can bring some peace to patients questioning if leg lengthening surgery is dangerous and risky. However, despite the peace of mind afforded by modern technology, height surgery can turn out to be dangerous if the patient or the surgeon is ill-prepared and inexperienced. 

Three Tips to Increase the Safety of Leg Lengthening Surgery

While potential patients can’t guarantee a 100% safe surgery and satisfactory results, they can lower chances of complications and improve recovery times by following a three simple tips.

1. Pick an Experienced Surgeon

With an inexperienced surgeon, limb lengthening surgery may be dangerous! So, it’s crucial to to vet a leg lengthening surgeon before going through with anything. 

Don’t choose a surgeon solely based on the price tag – prioritize experience over discounts when looking for a surgeon. An experienced surgeon will have a long track record of successful surgeries, multiple scholarly publications, put the patient’s safety first, and have proper after-care procedures. 

If patients cannot afford an experienced surgeon, they should take the time to save up instead of going with a shady professional. 

2. Opt for Modern Fixation Devices

It’s evident that modern internal fixation devices are much safer than the external fixators of the past, almost guaranteeing a successful lengthening. Besides, they speed up the healing process significantly, and the STRYDE heals femurs faster than the PRECICE [7].

Since patients can even walk with nails like the PRECICE STRYDE, they also don’t lose as much physical ability as other methods. These devices are the perfect answer to the doubt, “Is limb lengthening safe?”

3. Physical Therapy

With proper physical therapy, patients can reduce the chances of short-term problems like soft tissue stiffness and pain and long-term issues like axial deviations (knock knees and bowlegs). Doing PT and strengthening exercises before and after surgery does nothing but good for patients.

However, patients should get physiotherapy through a reputable professional instead of cutting costs. Like Dr. Paley at the Paley Orthopedic & Spine Institute, many surgeons provide PT within their surgery package as it’s indispensable for proper recovery [8]. 

In the end, risk reduction comes down to proper pre-operative research and diligent post-operative care. Patients should also ensure adequate social support or procure funds for a home aide to avoid putting too much pressure on their legs. 

So, is limb lengthening surgery dangerous? To some extent, it is, but optimizing physical therapy, opting for modern lengthening devices, and picking the right surgeon can significantly reduce the risk. 

References

[1] Rozbruch, R. (2020, April 28). Limb Lengthening: An overview by s. Robert Rozbruch: HSS. Hospital for Special Surgery. https://www.hss.edu/conditions_limb-lengthening-overview.asp 

[2] Paley, D. (n.d.). Cosmetic Stature Lengthening Frequently Asked Questions (FAQ’s). Paley Orthopedic & Spine Institute. https://paleyinstitute.org/wp-content/uploads/Cosmetic-Stature-Lengthening-FAQs15.pdf 

[3] Lee, R. C., Aulisio, M., & Liu, R. W. (2020). Exploring the ethics of stature lengthening as treatment for height dysphoria. Strategies in trauma and limb reconstruction. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8121106/ 

[4] Hosny, G. A. (2020, March 5). Limb lengthening history, evolution, complications and current concepts. Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058770/ 

[5] Paley D. (1990). Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clinical orthopaedics and related research, (250), 81–104. https://pubmed.ncbi.nlm.nih.gov/2403498/ 

[6] 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 

[7] Galal, S., Shin, J., Principe, P., Khabyeh-Hasbani, N., Mehta, R., Hamilton, A., Rozbruch, S. R., & Fragomen, A. T. (2021). STRYDE versus PRECICE magnetic internal lengthening nail for femur lengthening. Archives of orthopaedic and trauma surgery, 10.1007/s00402-021-03943-8. Advance online publication. https://pubmed.ncbi.nlm.nih.gov/33983528/ 

[8] Paley Orthopedic & Spine Institute. (2018). Costs & Financial Considerations. Paley Orthopedic & Spine Institute. https://paleyinstitute.org/centers-of-excellence/stature-lengthening/costs-financial-considerations/#/