What is Limb Lengthening
The first case of leg-lengthening was performed by Prof. G. A Ilizarov in 1972. His extensive work on the principles and applications of compression and distraction ontogenesis revolutionized fundamental concepts of orthopedics. Limb lengthening is one of the applications of his extensive work on distraction ontogenesis.
Newer surgical (LON) innovation in usage with experienced hands has befitted hundreds of people intending for Height gain.
The entire procedure includes the following steps:
The initial consultation starts with meeting with Dr. Sarin and his team wherein the entire procedure is explained and detailed history of the patient is taken. Further a thorough psychical and psychological evaluation is conducted which includes X-rays and measurements of the limbs. The patient is also shown the rehabilitative unit where they will be placed and are made to meet other limb lengthening patients prior the surgery. All questions and queries are personally addressed by Dr. Sarin and his team and an informed consent of the patient is taken prior the surgery.
Surgery and Distraction Phase
The lengthening phase surgery consists of an osteotomy (cut to the bone on both tabia and fibula) that will separate the bone into two segments and the special orthopedic apparatus (designed by Dr.Ilizarov) and internal nail is placed in the intramedullary canal of the leg bone. The patient is kept in the hospital for the next four days for pain less procedure by using epidural injection pump, so as to reduce the pain in the legs post surgery. The patient is closely watched for any signs of complications from the procedure and immediately addressed. Following the fourth day the patient is released from the hospital and sent to the rehabilitative unit where other patients are housed as well.
The distraction phase (lengthening phase) starts from the tenth day of surgery and about 1mm distraction is done in a day. The procedure is usually performed on for both legs at the same time and maximum possible leg lengthening is 7-10 cms in leg bones. X-rays are taken at respective durations in order to see the progress of the distraction phase.
During the treatment the patients are active. The day after operation all of them find it easy to move about without any help and can walk home with the help of supports and wait for consolidation.
Post three months when the desirable length is achieved, a second surgery is performed to remove the external device and interlocking the nail to prevent the loss of length is done. This surgery is imperative in the lengthening process and from here on is when the consolidation phase begins.
The consolidation phase includes intensive bed rest, physical therapy and regular X-rays post 6 weeks, this is done in order to ensure that the regenerate bone is optimum and strong to wear bear. The patient maybe allowed to walk on crutches during this phase and in some cases even allowed to go home. This entire phase lasts for about a period of 12 weeks from the day of second surgery.
Throughout the distraction phase, the patients are provided with trained physiotherapists who provide intensive physical training to the muscle in order to reduce stiffness. The patients are given physical therapy on a daily at rehabilitative unit.
How long does it take?
The whole process of leg-lengthening can take upto 3 months and 3 months for recovery. You’ll need to use a wheelchair if your weight is more than 60 to 65 kg.
Like any major surgical procedures, leg lengthening surgeries can also develop complications. However most of these can entirely avoided by meticulous preoperative preparation and planning. Rarely complications are encountered and have been dealt with appropriately by Dr. Sarin.
- Metabolic disorders
- Personality problems
- Uncooperative patients
- Poor bone quality
- Peripheral vascular diseases
Currently there are two technologies available for the height gain procedure known as the Lengthening on Nail “LON” and Hydraulic Lengthening Nail “HLN”.
The LON Technology
The Lengthening on Nail is an external procedure commonly called as the LON is performed by surgically inserting an intramedullary (IM) nail after making a precise hole in the bone which shall be at least 1½ mm in diameter larger than the diameter of the chosen nail. The length of the nail varies on the height of the patient and is usually chosen to be 3 to 5 cm short of the ankle joint. Standard locking IM nail of an reputed internal brand are used for the procedure.
After the IM nail has been inserted, two screws are inserted towards the end of the nail. An external Ilizarov construct is then fixed to the limb to facilitate the distraction process.
Upon the completion of the distraction process ie. 3 months, the external construct is removed.
The benefits of the LON Procedure are:
- Time period for the external construct is less
- Reduced rate of infection
- Prevents fractures in the regenerated bone
- Minimal scars
The Hydraulic Lengthening Nail Technology
The Hydraulic Limb Lengthening Nail is an internal procedure which successfully combines the three principles in its performance. The HNL is based on the concept of fluid mechanics as described by Blaise Pascal (French mathematician and philosopher 1623-1662). The second concept being that of the distraction osteogenesis (lengthening and transport), as described by Gavril A.Ilizarov (1921-1992) and third being the concept of metallurgy using weight bearing cobalt chrome.
The Hydraulic Limb Lengthening Nail for limb lengthening works strictly on the principle of liquid mechanics. Through controlled pressure build-up in the pressure chamber of the intramedullary nail, two metal components are extended from each other. The hydraulic device is externally activated by a mechanical hand pump attached to a tube which is surgically removed at the end of the procedure. The use of the hydraulic intramedullary nail for limb lengthening/transport/compression of bone segments (femur and tibia) is one of the safest methods which has taken over 5 years in its development. So far this nail has proven to be fully stable, reliable with high level of comfort for the patients.
The Hydraulic Limb Lengthening Nail is manufactured from biocompatible corrosion durable hardened cobalt chrome surgical steel. This has a tensile strength 3 times higher than stainless steel. All seals used in the HNL are completely biocompatible. The marrow device is able to generate a displacement power of 110 Kg ~ 200 pound and the marrow hydraulic device resists a vertical load of approximately 4.000 Newton ~ 400 Kg. The HNL is a complete weight bearing intramedullary nail.
Advantage of the HLN:
- Minimal pain; patients feel mild pressure during pump activation
- Manufactured completely from cobalt chrome surgical steel
- Fast paced and quick mobilization during the distraction stage
- Complete mobility to patient allowing them to walk with minimal exposure to environment
- Due to the cobalt chrome steel, the nail is 100% weight bearing
- Low rate of infection at the site of the flexible inlet tube during distraction stage by practicing basic surgical hygiene
- Controlled longitudinal distraction
- As well as antegrade or retrograde positioning of the Hydraulic marrow nail is possible.
The above advantages have been observed based on over 40 HLN surgeries conducted on patients of various ethnicities so far and the results have been satisfactory making this technique successful.
The result of height gain surgery varies from 7 cm to 10 cm depending on the requirement of the patient and healing capability.
X- ray taken after 10 days of the HLN procedure
X- ray taken after 1 month showing height gain of 3.5 cms
X-ray after completion of the HLN procedure with height gain of 6.5cm
Patient walking during lengthening with HLN procedure
A collection of answers to the most common questions our patients frequently ask before coming to us. If your question is not part of this list, we encourage you to use the Contact Us Form.
Going through a limb lengthening surgery is often an emotional experience borne out of the desperation of our desires to be better accepted in society. Many of our patients have a lot to say about their surgical experience. Read the outstanding stories of their limb lengthening journey.