Limb lengthening side effects, complications and risks
Every year, thousands of people undergo limb lengthening surgeries to become taller and the demand is higher than ever. Thanks to the newly developed technologies and under the guidance of an experienced doctor, it is possible to safely achieve height gain by limb lengthening. However, as we all know, it is one of the serious and invasive procedures among all cosmetic treatments, and there are a number of things that may go wrong. In this article, we will try to cover most of the possible complications, side effects and risks of limb lengthening procedure. We will mainly discuss limb lengthening side effects, complications and risks encountered in the POST-surgery period, supposing that the surgery has been performed successfully.
The main and most common side effect of this surgery is pain, which is quite natural. All of our patients experience varying degrees of pain at least on some points of their procedure. As you probably know, the bone is cut with special tools during bone lengthening surgery. This is called osteotomy. It is a major cause of pain, especially in the first few days after surgery. If the applied surgery method involves external fixation, such as Holyfix, Ilizarov or LON, then there are metal pins used to attach the fixator to the leg. These pins pierce the soft tissue and go through the bone, and the caused damage to soft tissue also causes pain. These two kinds of pain go away or at least subside after approx. 1-3 weeks from the surgery.
Then there is another kind of pain, which begins to show itself when patients reach a certain amount of bone lengthening. This type of pain is caused by the nerves being stretched and experiencing high tension. For some people it may happen when patient reaches 4-5 cm, for others it may be 6 cm or 7 cm. To reduce the tension in legs, the muscles of legs have to be trained and adjust themselves to the new length of the bones. It can only be achieved by physiotherapy sessions and stretching exercises. If these are not done, the tension will remain and so will the pain and limitations of movement.
It is quite typical to see your legs and feet becoming swollen, right after you wake up from your limb lengthening surgery. This is due to oedema, which is our body’s natural reaction to surgical injuries. The swelling of the legs and feet reduces significantly in approximately 10-15 days after surgery and disappear over time. This symptom is nothing to worry about.
Being unable to extend or fully move limb or joint
It mainly happens due to daily stretching of bones. We see our patients having difficulties to move their knee as they wish, and the limitation increases as they make progress with their bone lengthening. You may prevent this symptom from becoming worse, by exercises and physiotherapy, and try to be as physically active as possible throughout the day. Too much rigidity, sitting or lying on a bed will do no good for a limb lengthening patient.
Infection is one of the possible complications when external fixation is involved. Here, we are mainly speaking about methods such as Ilizarov, Holyfix and LON. The pin sites, where the pins enter the skin, are in form of circular openings. These are covered with bandages treated with antiseptics, right after the surgery. It is very important to change these bandages regularly, and treat the wounds with antiseptics to avoid infection. However, approximately 2-3 patients out of 10 patients get infection. It is not difficult to find out you have infection. The typical symptoms are: redness, swelling and increased pain at the pin sites, as well as yellow pus and discharge. It takes some time for the surface infection to turn into something serious, but patients must inform their doctor as soon as they find out there is something wrong with pin sites. It is quite treatable with oral antibiotics, combined with local application of antiseptics, in short period of time, usually in 1 week or so.
It should be noted that in patients who undergo Precice 2 or Stryde surgery, we don’t see infection cases because there is simply nowhere to get infection into. I mean, after the intramedullary nails are implanted, the cuts are stitched. This is one of the advantages of internal methods over other limb lengthening methods with external fixation.
Slow union/non-union of bones
It is when bones take longer time to heal and consolidate, or refuses to heal at all. The possibility is higher when patients age is more. For example, bones of a patient in his mid 40s is more likely to consolidate more slowly than a patient in his 20s. Another significant factor which deteriorates bone consolidation speed is smoking. According to scientific researches, smoking increases the total recovery time by up to 3-4 times. For this reason, we don’t accept cigarette smoking patients unless they give up smoking months before their surgery.
There is one more factor affecting bone healing process speed, and it is the amount of bone distraction. A bone, distracted by 7-8 cm takes more time to heal, compared to a bone lengthened by 5-6 cm for example.
Some of the extra treatments to increase bone healing process are: PRP (platelet rich plasma) therapy and Hyperbaric Oxygen Therapy.
If the bone is not consolidating at all, the distraction process may be reversed. By shortening the bone a little bit, it can be possible to trigger bone regeneration. In case this doesn’t help either, then with a corrective intervention, the surgeon may trim both ends of non-uniting bone, and then wait a little more for bone to heal.
Bone regeneration process is a challenging and demanding process for human body. Many patients lose significant weight during recovery period. It is very important to supply enough nutrients for the body, to prevent body weight loss and help the regeneration process. The food must be rich in calcium, phosphorus and vitamin D.
Faster than normal bone union
It is even rarer than slow union. The optimum bone distraction rate is 1 mm/day for the great majority of patients. This speed is slow enough to ensure the soft tissues aren’t exposed to abrupt tension increase and damage, and fast enough to prevent early consolidation of bones. If a patient’s bone consolidates so much during bone distraction, that it makes bone lengthening impossible or difficult, it is early bone union. If you feel too much resistance when turning the key or using electronic controller during bone distraction, it is necessary to inform your doctor, because your bones may have consolidated early and the nail or external fixator may get stuck and not extend further. This kind of complication can be treated by a secondary osteotomy, which is re-cutting the affected bone, allowing the process to resume. Or, if enough bone distraction has been done and both legs are of equal lengths, the process may be terminated.
This happens when blood clots clog the veins and severely disrupts blood circulation. A type of thrombosis is called deep vein thrombosis, when it occurs inside a vein deep in the patient’s body. In other cases, the blood clot may end up in lungs, which is called pulmonary embolism. Thrombosis in general is a serious complication and there is a small possibility of death, if symptoms are not detected and controlled in time. However, as a standard procedure, our patients are given blood thinner medications, which makes the blood difficult to clot, and keeps clot sizes minimum, so that they don’t close a major blood vessel.
The mechanism of occurrence is very similar to thrombosis, but it is caused by fat, travelling through blood stream and causing damage to organs. This type of complication may especially happen in long bone fractures, which is the case in limb lengthening surgery. Luckily, the risk is significantly smaller, when the broken bone is fixed immediately, which is also true for limb lengthening operations. Fat embolism also has a possibility of mortality, however our surgeon and medical team does everything possible to keep the possibility of thrombosis, fat embolism and consequent mortality risk at minimum.
It should be noted that the possibility of these serious complications is extremely lower compared to other minor complications, and these kind of risks are not specific to limb lengthening operations but to most types of surgical procedures.
It is possible to get a nerve damage if you attempt to do extreme amounts of bone distraction. Usually, for the majority of patients, femur lengthening max limit is 8 cm, and tibia max limit is 7 cm. Patients are at their own risk if they neglect doctor recommendations, and increase daily bone distraction rate, or attempt to prevail the maximum total limits. As a consequence of excessive tension, nerves may get damaged, and this damage may be permanent. In this scenario, there is a possibility of losing the sensations or mobility in the affected limb. A condition called drop foot may occur, due to the damage to peroneal nerve.
Please feel free to check our detailed and extensive video about limb lengthening side effects, complications and risks: