Leg lengthening surgery: A safe yet complex procedure to augment height
“Doctors calculate achievable bone lengths, then lengthen the shorted leg or delay the growth of the longer leg as appropriate.”
Advancements in medical technology and knowledge have significantly improved the safety of leg-lengthening surgery performed by orthopedic surgeons. These advancements have reduced the risks and complications associated with the procedure. In addition to correcting discrepancies in leg lengths, leg-lengthening surgery has become an intriguing method for height enhancement among the general population.
However, relying solely on the expertise of an orthopedic surgeon may not guarantee the results and success one may hope for. If you are considering height increase surgery, you are encouraged to read the interview with Dr. Songkiat Thanacharoenpanich, an orthopedic surgeon specializing in pediatric orthopedics and deformity at MedPark Hospital, he reveals critical factors that influence treatment outcomes. Let us dive in.
Leg lengthening surgery: Primarily for treating disease and disorders
Dr. Songkiat discusses the concept of bone lengthening surgery as crucial for treating diseases and deformities rather than purely for cosmetic purposes. He explains that bone lengthening can be performed on various bones, such as the femur (thigh bone), tibia (shin bone), and others, using principles of osteotomy (bone cutting) and gradual distraction osteogenesis (bone growth by gradual distraction). There are four types of bone deformities:
- Congenital
- Traumatic
- Cancer
- Infectious deformities.
"We lengthen bones in patients with leg length discrepancy due to various causes, such as genetic conditions causing bone deformities or unequal lengths, bone tumors, bone infections, or non-union of fractures. In some cases, broken bones penetrate the skin, must be cut off, and require the lengthening of remaining bones for bone fusion. All of these cases rely on the same treatment principles."
For treating congenital leg length discrepancy or diseases that cause unequal development of bone tissues in the leg, Dr. Songkiat emphasizes that achieving equal leg lengths is paramount, even if at the cost of slightly shorter overall expected height from the outset.
"In cases of children with congenital leg length discrepancy, it is essential to know what the underlying condition is and at what age the treatment starts to predict their potential final height. We calculate the final lengths of each bone and then decide which method will be more suitable: either lengthening the shorter leg or delaying the growth of the longer leg by compressing the growth plate. The latter method ensures that child achieves equal leg length at a height of 165 cm instead of full-potential height at 170 cm but with unequal leg length."
The periosteum is what lengthens the bones.
The lengthening of bones is possible through the growth of the periosteum, the tissue surrounding bones. Under normal conditions, the part of a broken bone that bridges the bones is not the bone tissue but the periosteum covering the bones. Therefore, treatment begins with intentionally fracturing the bone and securing and immobilizing the bone ends with a device resembling metal rings. Subsequently, the bone ends are gradually separated at 1 mm per day to create a gap for new bone tissue to fill.
"We rotate the rings to separate the ends from each other 1 mm a day. Patients can rotate the device themselves at home. After two weeks, we assess the wound. After a month, we take an X-ray to assess progress. If the rotation is correct, we start to see some new tissue forming to fill the gap, but it is not yet strong enough. Suppose the target is to lengthen by 3 cm; we will perform the lengthening process for 30 days, then stop and wait at least two months for the new bone tissue to be strong enough. During this time, monthly checks are necessary until the bone is fully fused and strong. Then, we can remove the ring fixators surgically."
Other than a ring fixator, another method is to insert an internal rod into the marrow of the bone with an external ring attached, which means the new bone tissue will grow over the metal rod.
"This technique is often performed in the tibia. Once we have achieved the desired length through gradual stretching, we secure the metal rod with fixation screws. We can then remove the external ring fixators. The length gained remains stable because the internal rod inside is secured with screws on both sides of the bones, allowing new bone tissue to consolidate and strengthen properly over time. This approach reduces the duration that ring fixators must remain in place until full healing of the fracture. It decreases the infection risk of the prolonged skin penetrating pin tracks."
The reason patients raise the white flag for bone lengthening
The theoretical limit of bone lengthening is 1 millimeter a day. However, this does not mean one can continue lengthening as much as one would like. There are nerves, tendons, and other tissues surrounding the bone that come into play. For example, a patient might like to lengthen their bone by 8 centimeters, but only 5 centimeters is achievable.
"One millimeter per day is a standard recommended lengthening rate. After rotating a ring fixator, you will start feeling the tightness; it is unlikely anyone can stretch beyond that. It is not advisable because it is risky, potentially causing injuries to surrounding tissues. Moreover, surrounding ligaments and nerves cannot stretch or regenerate like bone tissue. They will become taut and could lead to joint dislocation or subluxation, which is why the procedure stops midway."
Not only do physicians have to be concerned about ligaments and nerves, but so should the patients, especially for wound care. External ring fixators and internal rods are at risk of pin tract infections through the skin, particularly early after surgery.
Before taking the plunge, physicians should have a heart-to-heart discussion with patients about their commitment to the procedure for a year. Can they commit to this treatment despite potential risks and complications? It is essential to assess whether the patient can accept these risks. Is it acceptable if the whole procedure is unsuccessful?
"During the process, patients must endure considerable discomfort and be patient, especially those seeking height increase for aesthetic reasons. Doctors must lengthen both legs simultaneously, making it impossible for them to walk unaided. They require constant support and assistance for mobility and cannot engage in exercise during this period.”
"Lack of walking can lead to thinning of bones and muscular atrophy, which is discernable through an X-ray. Once treatment is complete, the patient can walk normally again, and everything will return to normal. However, it depends on how long the patient can endure having metal in their body. Many give up halfway because it takes not just days, but months or even years."
Reading up to this point, many of you may imagine what daily life would be like with ring fixators attached to their legs 24 hours a day. Aside from the pain, standing, walking, sleeping, and moving would be challenging. Nevertheless, enduring and living with these devices throughout the treatment is necessary. We extend our support to everyone committed to making this significant change in their life.
“Leg-lengthening surgery to augment height is unlike other cosmetic surgeries, such as nose jobs, where you see immediate results with silicone implants. This process takes much longer, and results are not immediate. However, if you truly wish to proceed, start with a consultation. Put trust in the experience of the doctors. Be patient and determined. We can achieve successful results together.”
