Limb Lengthening Surgery Procedure and Recovery

Limb lengthening is a surgical procedure conducted in patients who want to achieve a tall stature or have a difference in the height of their limbs (arms or legs) due to genetics or some previous medical or surgical history. It is important to note that limb lengthening is a complex and invasive procedure with risks and complications. Patients who are planning to consider this surgery should consult with a qualified orthopaedic surgeon to discuss their specific needs and expectations, as well as the potential benefits and risks involved.

Limb length differences are mainly found in Humerus (upper arm bone), Radius/ulna (forearm bones), Femur (thigh bone), and Tibia (shin bone). There are many patients who travel to India for cosmetic limb lengthening because they are not satisfied with their current stature and wish to gain height. For them, the procedure is also referred to as height increase surgery.

The following blog explores more about the lengthening process, possible risks, and the duration of treatment. It is important for patients, especially those looking for height increase surgery to understand all aspects associated with the procedure.

How Does Limb Lengthening Surgery Work?

Limb lengthening surgery is divided into three phases, which are described below: 

• Surgery: In the first phase, the surgeon makes a cut in the bone that requires lengthening. This is done in a very specific way to preserve blood flow and other biological processes that help bones heal. Once the cut has been made, the surgeon attaches the lengthening device to the limb. This device, called a fixator,  creates a gap in the bone to enable the lengthening process. Patients stay in the hospital for at least two to three nights after this procedure. The second stage begins after 7 to 10 days of the surgery.
• Distraction: During the second phase, the two ends of the bone are gradually separated, stimulating new bone to grow and fill in the gap.This stage typically takes up to 2 to 3 months. The average distraction allowed is about 0.75 to 1 mm a day. During this stage, the clinical team carefully and regularly monitors the bone and surrounding muscles, tissues, and nerves. If any changes are needed in the daily distraction process, it is handled by the team as per the progress of the patient.
• Consolidation: Once the limb reaches the desired length, the body continues to fill the gap with the new bone, while muscles, nerves, tendons, and ligaments around the bone adjust to the new length. This process takes another three months to complete. The fixator is removed before the consolidation phase begins and the patient is able to walk with the help of support at the same time.

Types of Limb Lengthening Surgery

Here’s an overview of the most popular limb lengthening methods, highlighting their unique approaches and key aspects:

Lengthening Over Nails (LON)

The Lengthening Over Nails (LON) method is a hybrid approach that combines external and internal fixation for limb lengthening. First, an external fixator is applied to create controlled bone distraction, which stimulates bone regeneration. Once a sufficient length is achieved, an internal nail is inserted within the bone canal. This nail provides stability, allowing for quicker rehabilitation and reducing the duration that the external frame is required. The LON method is popular because it minimizes external fixator time, improves comfort, and allows patients to bear weight sooner, but it does involve two surgeries (fixator application and nail insertion).

Ilizarov Method

The Ilizarov method, developed by Dr. Gavriil Ilizarov, is one of the oldest and most well-established limb lengthening techniques. This method relies solely on an external fixator frame that encircles the limb and is attached to the bone with metal pins and wires. By adjusting the frame, gradual bone distraction occurs, allowing new bone to form in the gap created. The Ilizarov method is highly versatile and is effective not only for lengthening but also for correcting deformities and complex bone fractures. However, the fixator must be worn for an extended period, and patients may experience discomfort and pin-site infections due to the long duration of the external frame.

PRECISE Method

The PRECISE method is an advanced, minimally invasive approach using an internal, motorized nail system called the PRECISE Nail. This telescopic nail is inserted surgically inside the bone and can be lengthened gradually using an external magnetic controller. The PRECISE method is highly precise and eliminates the need for an external fixator, making it more comfortable and aesthetically preferable. It’s also associated with fewer complications and shorter recovery times. However, this method is expensive and requires specialized equipment, which limits its availability. It's particularly popular among patients who prefer minimal visible hardware and a faster recovery.

Rail Fixator

The rail fixator method uses an external, sliding frame attached to the bone with screws and pins. This linear, rail-like fixator allows controlled lengthening by sliding the rail gradually. The rail fixator is particularly effective for patients requiring straightforward, linear bone lengthening. The device provides stability and support during the process, though it does involve prolonged use of an external frame. While simpler and more affordable than some other methods, it shares common drawbacks of external fixation, such as discomfort and risks of infection at pin sites.

Each method offers distinct advantages depending on the patient's needs, recovery goals, and tolerance for external devices. The choice typically depends on the patient's clinical needs and personal preference for either an external or internal system.

Why Choose India for Limb Lengthening Surgery

The cost of limb lengthening surgery in India is significantly  lower  than in countries such as the United States, Canada, the UK, or Australia. In India, the limb lengthening surgery cost ranges from $7500 to $11500, depending on the technique, hospital, and the patient's specific needs. In comparison, similar surgeries can cost over $75,000 in Western countries.

Below are some of the major reasons why some looking for cosmetic limb lengthening should choose to fly over to India to get it done:

Cost-Effective Treatment

India is renowned for providing world class limb lengthening procedures at a low prices, especially compared to the Western countries. The cost effective options do not compromise on quality, as facilities focus on delivering safe and highly effective treatment options. Surgeons and hospital staff work collectively to minimise treatment cost, including preoperative planning, surgical procedures, and aftercare support.

State-of-the-Art Hospital Infrastructure

Advanced medical facilities that specialise in limb lengthening surgery have more than just highly trained employees. They have the facilities required to handle complex surgeries. These facilities include modular operating rooms, bedside X-ray machines, and hospital infection control that meets high standards. The purpose of these facilities is to guarantee the greatest possible outcome for the patient. Effective and accurate operation planning is made possible by advanced imaging and computer assisted technologies, such as 3D scans and MRIs; in addition, specialised postoperative care rooms guarantee patients' safety and comfort following surgery.

Experienced Surgeons for Cosmetic Limb Lengthening

The highly skilled surgeons who have many years of training and experience in orthopaedic and cosmetic limb lengthening procedures have specific training in this area. These advanced surgeons have mastered contemporary methods such as the Ilizarov technique, lengthening over nails (LON), the PRECICE nail and other techniques that are at least invasive. Several of these doctors have also been certified by other countries which increases the faith in their skills and abilities.

Excellent Aftercare Facilities for Comfortable Stay

The aftercare of the patient is crucial in the case of limb lengthening surgery, which involves a progressive recovery. Such patients are accommodated either in specialised rehabilitation centres or in nursing homes that have a combination of medical care and comfort. Such places have personal attendants who are trained for the work, and  medical attention. It also takes care of their nutritional needs, dressing change, bedside physiotherapy, inhouse X-rays and everything else. For long term treatment, the stays become more homely, thus helping ease the prolonged period of aftercare.

Cost-Effective Physiotherapy Services

Physiotherapy has an important role in limb lengthening rehabilitation because it assists the patients in getting back their mobility and strength step by step. Institutions which provide economical physiotherapy as well as inhouse services also ensure consistent attendance of patients with the skilled staff. After limb lengthening, therapists trained in rehabilitation are ready to offer therapy such as hydrotherapy, stretching, balance training, etc. to optimise healing and better improvement.

Limb Lengthening Surgery: Possible Complications & Their Prevention

Limb lengthening procedures, though generally successful, carry a range of potential complications. These range from common issues, like pain and stiffness, to rare but serious complications, such as nerve and vascular damage. Proper management and proactive measures can reduce the risks and aid in recovery. Here’s a breakdown of common and rare complications and their preventive strategies:

Common Complications

• Pain and Discomfort
  • Cause: Distraction of bone and stretching of muscles, nerves, and tendons.
  • Prevention/Remedy: Pain management includes prescribed analgesics and, in some cases, nerve-blocking agents. Regular physiotherapy can help ease stiffness, reduce pain, and enhance muscle flexibility. Gradual lengthening and careful monitoring can help prevent excessive pain.
• Pin-Site Infections (with external fixators)
  • Cause: Bacterial infection around the pins or screws used in external fixators.
  • Prevention/Remedy: Proper pin-site care, including daily cleaning with antiseptic, is essential. Broad-spectrum antibiotics are prescribed if infections arise. Regular pin checks and dressing changes help minimise infection risk.
• Joint Stiffness and Contractures
  • Cause: Prolonged immobilisation or tightness of muscles and tendons during lengthening.
  • Prevention/Remedy: Daily physiotherapy and stretching exercises are vital for maintaining joint mobility. If stiffness persists, joint mobilisation under the guidance of a physical therapist can help. Ensuring gradual, controlled lengthening also reduces the risk of contractures.
• Delayed Bone Healing (Delayed Union)
  • Cause: Slow bone regeneration, often due to insufficient blood supply or nutritional deficiencies.
  • Prevention/Remedy: A balanced diet rich in protein, calcium, and vitamins D and C supports bone healing. Supplements, particularly calcium and vitamin D, should be taken as prescribed. Bone stimulation therapies, such as ultrasound or electrical stimulation, can be applied if bone growth remains slow.
• Soft Tissue Tightness
  • Cause: Stretching of muscles and ligaments during bone lengthening.
  • Prevention/Remedy: Regular stretching, deep-tissue massages, and physiotherapy help alleviate tightness. Maintaining gradual and conservative lengthening reduces the strain on soft tissues. Specific strengthening exercises for the muscle groups around the lengthened bone are also beneficial.

Rare Complications

• Nerve Injury or Neuropathy
  • Cause: Compression or over-stretching of nerves.
  • Prevention/Remedy: A conservative lengthening rate, typically less than 1mm per day, reduces the likelihood of nerve damage. Monitoring for signs like numbness or tingling is crucial. Neuropathy can often be treated with medications and vitamin B12 supplements, or temporary pauses in lengthening may be necessary to allow nerves to adjust.
• Vascular Injury
  • Cause: Excessive lengthening or unintentional compression of blood vessels.
  • Prevention/Remedy: Regular vascular monitoring (checking pulses and capillary refill) is essential to detect any circulatory issues early. In severe cases, reducing the lengthening rate or even surgical intervention may be needed.
• Nonunion (Failure of Bone to Heal)
  • Cause: Poor bone regeneration, often due to inadequate nutrition or compromised blood supply.
  • Prevention/Remedy: Adequate intake of bone-supporting nutrients, such as calcium, vitamin D, and protein, is crucial. Supplements, especially vitamin D and calcium, help in bone mineralization. Bone grafting or advanced regenerative therapies may be required in severe cases of nonunion.
• Fractures
  • Cause: Weak or insufficiently healed bone during or after lengthening.
  • Prevention/Remedy: Patients should avoid weight-bearing activities until the bone is fully consolidated. Regular X-rays help monitor bone strength and healing. Protein-rich foods, calcium supplements, and vitamin D promote bone strength. In some cases, additional bracing or support may be recommended.
• Malalignment or Deformity
  • Cause: Inconsistent or uneven lengthening, especially with external fixators.
  • Prevention/Remedy: Accurate device adjustment and monitoring during the lengthening process minimise the risk of malalignment. If a deformity occurs, realignment surgery may be necessary.
• Muscle Atrophy
  • Cause: Reduced activity and immobilisation of muscles.
  • Prevention/Remedy: Regular physiotherapy, including strength-building exercises and weight-bearing activities when feasible, prevents muscle atrophy. A high-protein diet supports muscle repair and regeneration.

General Preventive Measures

• Diet and Supplements: A balanced diet with ample protein, calcium, and vitamin D is essential. Calcium and vitamin D supplements help enhance bone mineralization, while protein supports soft tissue repair. For patients at high risk of delayed bone healing, vitamin C and other bone-boosting nutrients may also be recommended.
• Physiotherapy and Regular Exercise: Physiotherapy promotes flexibility, strength, and mobility. Daily stretching, strengthening exercises, and weight-bearing activities (as allowed) are key to reducing stiffness, muscle atrophy, and other soft tissue complications.
• Monitoring and Regular Follow-Ups: Frequent check-ups, including X-rays and nerve checks, help ensure any early signs of complications are addressed promptly. Regular follow-ups allow the medical team to adjust the treatment plan as needed.

Adopting these proactive measures and maintaining close collaboration with the medical team significantly reduce complication risks, leading to a smoother and faster recovery in limb lengthening procedures.

Is Limb Lengthening Surgery Painful?

Yes, limb lengthening can be painful when the effect of anaesthesia goes off. The patient may also experience some pain or soreness during the distraction phase. Many patients are prescribed pain relieving medicines to manage the situation. However, there are several ways to reduce the pain after the surgery:

• Medications: Pain relievers, over the counter, and prescription, are commonly used to manage pain after surgery. These may include nonsteroidal anti inflammatory drugs (NSAIDs), opioids, and other pain medications.
• Nerve Blocks: Anaesthesia can be used to numb the area around the surgery site, reducing pain for a period of time.
• Patient-Controlled Analgesia (PCA): PCA allows patients to self administer pain medication through a pump, giving them more control over their pain management.
• Physical Therapy: Physical therapy can help improve mobility, reduce pain, and speed up recovery.
• Elevation: Elevating the limb can help reduce swelling and pain.
• Relaxation Techniques: Techniques such as meditation and deep breathing exercises can help manage pain and anxiety.

What is the possible average lengthening that can be achieved?

The amount of bone lengthening depends on various factors including your age, which limb needs to be lengthened (arm or leg), and the current length of that limb.

• Typically, a bone can be lengthened 2 to 3 inches during a single lengthening cycle. If your limb length difference is greater than two inches, they may need to go through the procedure more than once over a period of 12 to 24 months.
• Shorter limbs may need to be lengthened in smaller amounts.
• In general, legs can be increased up to 25 percent of their original length per cycle.
• Arms can be lengthened up to 40 percent of their original length per cycle.