Pain after Limb-Lengthening Surgery

You should know about the pain after limb-lengthening surgery before deciding to go through this process, based on the limb-lengthening surgery methods, the person’s pain tolerance, what helps with the pain, and what one should avoid. In this article, you will be able to reach all this information and the questionnaire we did with our 10 patients about the pain they felt through the process.

Before you move onto reading the article, you can watch the short introductory video of Assoc. Prof. Dr. Yunus Öç, talking about the pain in limb lengthening surgery.

Pain Based on the Limb-Lengthening Methods

Regardless of the methods, there is pain for both the LON (Combined) and the Precice methods after the surgery and during the lengthening process. However, the pain is a little bit less with the Precice 2 method, compared to the LON (Combined) method. There are several reasons it is this way; first of all, there is an external fixator for the LON (Combined) method. This fixator is a little bit heavy and there are 4 pin nails (Schanz screw) that are inserted in the legs. These pin sites create sensitivity on the skin during the lengthening process. Because the pin sites create minimal cuts, the pain that is felt with LON (Combined) method is more than Precice 2 method. 

There is no external fixator for the Precice 2 method, there are only intramedullary nails but there is still some pain. We should emphasize that pain is subjective and changes from one person to another based on their pain threshold. The pain that is felt right after the surgery is relieved with the strongest painkillers. The first few days after the surgery are usually when the pain is felt the most.

For the patients of both methods, there is a companion that stays with the patient, who knows the patient’s language, during the lengthening process. Because the patients experience movement limitation during this process, the companion’s help is very important. This movement and walking limitation may cause some patients to feel down psychologically because the bones of a healthy person are being broken and there is a 5 to 6-month process waiting for them. Keeping these in mind, the person should prepare themselves before the process both mentally and physically. If the patient wishes, we can help them decide whether they are ready for the surgery or not with our psychologist service. With that said, we also provide psychologist service during the lengthening process if the patient wishes.

Does it Hurt during the Lengthening Process?

For both methods, because the muscles, tendons, nerves, and overall soft tissue lengthens 1 mm every day, the body aches accordingly. This pain decreases with the painkillers that are given by the doctor and the personalized physical therapy exercises. If the pain is intolerable during the lengthening process, the strongest painkillers are given to the patient under the doctor’s control. The pain during the lengthening process is especially felt at night, therefore, some patients have sleep problems as a side effect. If the patient’s sleep problem is severe, the doctor may give sleeping pills to the patient. Moreover, because some of the screw-turning times happen to be at night, we advise our patients to move their legs, massage them and do some exercises, so that the blood flow increases, some muscle groups are relieved and the pain is a little bit lessened. 

Hot Water Bag Usage

Especially before the physical therapy sessions, our physiotherapist recommends putting a hot water bag on the legs for 10-15 minutes in order for some muscle groups to relax as a preparation. Furthermore, 10-15 minutes before the physical therapy session, the patients do some warming exercises to prepare their legs for physiotherapy. 

Note: The Precice 2 method is recommended for patients with low pain tolerance by our doctor.

The pain increases for some of our patients after reaching 4 cm lengthening due to tension in some strong muscle groups and nerves. In that case, either physiotherapy sessions of the patient may be increased or some adjustments can be made to the dosage of painkillers that the patient takes with the doctor’s approval. This is valid for both the LON (Combined) and the Precice 2 methods. As we have mentioned before, the pain that the patient experiences changes from patient to patient because everyone’s pain threshold is different. Based on our patients’ feedbacks, the pain is felt more with the LON (Combined) method.

We highly advise anyone who plans to get the surgery to keep these in mind and then decide whether they want to go through this process or not. Although the process is long and a little bit painful, the reward you get afterward will make it worth it. In addition, there is no long-term side effects of the surgery.

Pain after Device Removal Surgery

For the LON (Combined) method, after the patient got their desired height, they get the device removal surgery. Although it is not as severe as the first surgery, the patient may still experience a little pain after the device removal. The pain is caused by the cuts that are made on the leg during the surgery, also, some locking nails are inserted in the legs before removing the external fixator completely. The hospital process after the device removal surgery is for 1 day. With their companion, the patient goes to their accommodation, which is Days Hotel by Wyndham Esenyurt, in the ambulance. For some patients, the process after device removal is a little bit painful, but for some it is comfortable. 

The pain that most of our patients experience decreases especially 1 week after the device removal surgery because there is no longer an external fixator, the Schanz screws that cut the skin, and the daily 1 mm lengthening. 

For the Precice 2 patients, pain decreases a lot right after the device removal surgery.

Do You Feel Pain during Medical Dressing?

The medical dressing is applied for 2-3 weeks after the limb-lengthening surgery with Precice 2 method, afterwards, the wounds are healed, therefore, there isn’t usually much pain for this method’s medical dressing. On the other hand, for the LON (Combined) method’s patients, medical dressing is usually a little painful because the nurse lets the pin sites absorb the antiseptic solution with the sponge for proper cleaning. 

Because the infection risk is high for the LON (Combined) method, the medical dressing is done 2-3 times a week during the lengthening process. There might be some pain, pressure, or burning sensation during the medical dressing. There is less pain during the medical dressing that is done after the device removal.

The Questionnaire We Did with Our Patients

With the questionnaire we have prepared by asking 10 of our patients, you can observe that the pain differs from person to person and from method to method.

1- Could you rate the pain you felt right after the surgery from 1 to 10?

The Lengthening Method- Section	The Rate of Pain (1-10)	Patient’s Feedback
Femur- LON (Combined)	4	The pain was tolerable
Femur- LON (Combined)	10	It was intense right after I woke up
Femur- LON (Combined)	2	It was more comfortable than I’d thought
Femur- LON (Combined)	3	Very comfortable, I was able to walk
Femur- LON (Combined)	5	I’d felt medium-level pain
Femur-Precice 2	6	It was painful for the first few days
Femur-Precice 2	2	I didn’t experience much pain
Tibia- LON (Combined)	1	It was very mild
Tibia- LON (Combined)	7	The first 3 days were hard
Tibia- LON (Combined)	2	I’d walked with ease after the surgery

Side Note: The patient that has said their pain was 10 out of 10, had used many pills before they came to get the surgery, therefore, they had immunity to the painkillers and even the strongest painkiller didn’t work for them. Therefore, we recommend stopping taking too many painkillers or pills, except for medicinal purposes, before your surgery. 

 

2- Were you able to sleep for the first few days after your surgery?

• 7 out of 10 of our patients answered that they had some sleeping problems for the first 3 days after the surgery and they had woken up every hour. Some of these patients preferred to take sleeping pills under the doctor’s control and some of them didn’t. During their lengthening process, 5 of these patients mentioned that their sleeping problem has lessened and 2 of them are still taking sleeping pills regularly.
• 3 out of 10 of our patients have said that their sleep isn’t affected by the surgery and they are able to sleep soundly without needing sleeping pills.

 

3- Was the pain during the process more severe than you had thought before?

• 7 of our patients have said that the pain was less than they have imagined or it was tolerable, our other 3 patients said that it was as painful as they have expected.

 

4- Did the painkillers help?

• All of our patients have said that the painkillers helped with the pain but the dosage of the painkillers changes from patient to patient, some of them took stronger painkillers while some of them took milder ones.

 

Based on the questionnaire we did with our patients, the lengthening process with the Precice 2 method is more comfortable than the LON (Combined) method but it can be observed that the pain right after the surgery doesn’t depend on the method but the person’s pain threshold. There isn’t a known difference between the femur and the tibia concerning pain but there is a difference between them for sleep comfort. The external fixators for the femur are at the side of the legs, therefore, the patient can only sleep face up but because the external fixator for the tibia stands in front of the patient’s legs, they can sleep on their sides, which is a little bit more comfortable.