In this article, we will try to provide an extensive guide to LON method, which is the surgery method preferred by the vast majority of our patients. This article will include most of the information you need about this surgery method, from the first days of the procedure till full recovery.
If we look back into the history of limb lengthening surgery methods, the first method used was Ilizarov method, which involved only external fixation. The used devices were circular external devices, originally developed by Dr Gavriil Ilizarov in the Soviet Union. These devices were of course a big development in orthopedics world but they have significant drawbacks as well. First of all, the devices are bulky and heavy.
Second, the wires that hold the bones together are prone to bending and breaking under patient’s weight, and these require replacements or repairs. Third and probably most important one, the period of fixation, in other words, the period during which the patients keep these devices on their legs, is the longest among leg lengthening surgery methods. The devices can only be removed if the bones have completely consolidated and have become strong enough. It is easy to imagine how physically and mentally challenging this period can be.
LON on the other hand, removes most of these difficulties off the shoulders of our patients. LON stands for Lengthening Over Nails. This method has two types of fixators used together: an external fixator and an intramedullary nail, which is implanted into the bone cavity. The external device can be an Ilizarov fixator, a monolateral (rod-like) fixator, or any other device developed by some doctor anywhere, it is mainly up to the preference of the surgeon who practices limb lengthening. Our doctors almost exclusively use monolateral Holyfix devices being produced by Ortovia in Turkey. Because it is much more compact, lighter, easier to maintain and it is easier to track your lengthening progress on the scale of the fixator.
I have to note that it is quite a challenge to have a good sleep while you have traditional Ilizarov devices on your legs for several months, which can cause significant distress, combined with the varying degrees of pain throughout the procedure.
We talked enough about the external part of the LON method, now a little about internal fixation. As we mentioned a rod is inserted into the bone, which plays a significant role. Firstly it adds extra stabilization to the bone by preventing deviations. Additionally, it allows a much earlier removal of external devices. With this approach, patients only spend around 3-4 months with external devices on their legs compared to 9 months up to more than 1 year in completely external methods such as Ilizarov. The internal nails continue to hold the bone from inside for some more time. They are removed after full consolidation of bones.
After the patient undergoes the surgery, there is around 5-7 days of hospitalization. Walking begins from the next day after surgery by taking a few steps with a walker. Of course the doctor, or his assistants, and someone from our team is there to reach out when patients take their steps.
Upon discharge from hospital, the patients are explained how to do their bone lengthening, how to clean pin sites and change bandages.
Usually after 3-5 days from the surgery, the lengthening begins.
Patients are free to return home and do the above mentioned things in their countries. But it is recommended to stay in Turkey for the duration of bone lengthening period.
The lengthening is done at the speed of 1 mm per day. At this rate, for example 6 cm is achieved in approximately 60 days, or 8 cm in 80 days. Up to this point, almost all limb lengthening surgery methods have the same sequence. In LON method, in 2-4 weeks after the end of bone distraction phase, when the bones have shown signs of consolidation, the external devices are removed. At this point, the patients experience a significant relief, the pain has reduced, it becomes a lot easier to move around.
In this period, most patients are able to walk with a single or a pair of crutches. After the removal of external devices, it takes another 1 month or 1.5 month to be able to walk without support. From now on, our patients are able to walk, commute to their studies and work, and do most of the things they do regularly. Sports and other heavy physical activity is not allowed until bones fully consolidate. It should be emphasized that the patient has to put real effort in physiotherapy and exercises to improve leg muscles condition, otherwise it will take longer to gain mobility and recover completely.
In the video below, you can see a patient after removal of external devices:
Climbing stairs and walking without support after limb lengthening surgery by LON method:
It takes approximately 1 year to 1.5 year for bones to completely heal. You find this out by providing xrays to your surgeon periodically, once in every month or two. The doctor will decide when it is possible to remove internal nails. The removal of these rods is optional. They can be removed later or just remain inside the bones, if patients prefer it that way.
There are some reasons why it is the most chosen surgery method by almost 70-80% of our patients. I mean, it is a great combination of a good price and several significant advantages over other methods. It is much cheaper than fully internal methods. Compare Precice 2.2 method with LON for example, where Precice is 35250 eur, while LON at 17000 eur is less than half of that price. At the same time it is a more comfortable procedure compared with fully external methods such as Ilizarov or Holyfix.
Almost all of our patients, with some exceptions, have a priority to get rid of external fixators as soon as possible. Early removal of external devices means less dealing with bandages, pin sites, and shorter time wearing loose trousers to feel comfortable with the fixators. Also, the external devices are one of the main causes of all kinds of pain and discomfort in limb lengthening patients.
Please check our detailed video about LON method: