Long Term Effects of Limb Lengthening - Part 2

Long-Term Effects of Limb Lengthening is one of the biggest concerns patients have and so we're going to go a bit more in-depth on a few other potential effects that could linger into your later years.

1. Osteoarthritis aka Articular degeneration 

The articular cartilage is the paved surface at the end of your bones where joints meet to help you get a smooth-gliding-like-effect for pain-free movement when you do things like squatting, running, jumping and so on.

Now if this cartilage undergoes enough wear and tear over the years, well, you probably guessed it, you could be in a world of pain later on down the line.  

So how does this ‘breakdown of cartilage’ occur? Well for one - bone malalignment. If your bone alignment deviates even just a bit from it’s natural axes you could cause repetitive shearing forces on the joint and thus expedite the breakdown of this special protective surface especially if you’re an active person who likes to do physical activities.

How can you avoid it - well if you’re working out, make sure you have perfect lifting form, reduce muscle imbalances and when it comes to limb lengthening - hope that the surgeon lines up your bones properly and monitors it along the way.

This especially true for femur lengthening patients who can possibly lengthen into a valgus causing the patient to develop a mild knock knee deformity. Most patients won’t have this issue as their current structure isn’t predisposed to such angulation.

2. Bone hypertrophy and or bony protuberances: 

When the surgeon performs the osteotomy by breaking the bone in order for you to lengthen your limbs it’s most likely going to consolidate a bit larger than before. This is the body’s natural way of reinforcing the break much like muscles do. 

Eventually bone remodeling should make it look like nothing ever happened, but in some cases the ossification of the bony callus where the break was, may in-fact remain stay bigger than before and not slim back down to size. 

3. Soft tissue puncturing: 

This applies to those who are getting external fixators - primarily in the femurs - as the metal pins can create weakened wall of fascia in the vastus lateralis which can eventually lead to hernias if you build enough muscle mass on your thighs and push through these weakened walls.

The external fixators could also lead to deeper scarring of the dermis which could also create adhesions and severe scar tissue buildup in the muscle itself which I believe could decrease ROM and thus performance to some extent unless you get some sort of treatment modality to realign those muscle fibers - ASTYM or the sort being a major hint here.

How do you avoid this - either opt for internal nail lengthening for the femur or save externals for tibias only.

4. Nerve irritation or numbness: 

When you get LL done a lot of times the nerves are stretched and can become irritated or even numb. Well this numbness or irritation can linger for years. 

I know I had some numbness in a small spot towards the fibular head but it has since come back but some patients might not get full sensation back so you have to realize that might happen and using one of the statements that the great surgeon once said “it’s the cost of doing business”

How do avoid it - lengthen at an appropriate distraction rate where your nerves can keep up and obviously do your stretching.

5. Decreased athletic performance:

After limb lengthening surgery there is always a chance you could lose some physical ability which is especially true for Cosmetic Limb Lengthening as you weren’t handicapped prior to the procedure. 

Stature lengthening patients should be focused on maintaining as much function as possible and regaining anything they lost in the 2-3 years post op.

What is the main reason performance could possibly be negatively affected? The answer is decreased functional muscle excursion which depends on how much length you get. 

A lot of patients tend to stick to a more conservative amount of length rather than pushing it to the extreme thus increasing chances of regaining full athleticism assuming you do 3 things…

1. Heal your bones fully and ensure proper alignment

2. Regain full ROM and acclimate to new bone length

3. Strengthen muscle through this full ROM

Achieving all of these could take years to do especially if you let time take its course but like I always say, go hard on your rehab for 1.5 years post op and you’ll be surprised how well you recover.

6. Varus and Valgus of the knee joint and or muscle imbalances:

For patients who have a Limb Length Discrepancy, even after they get LL done when their hip height is balanced, depending on how long they had the discrepancy, they can retain an angular deformity.

I know I still have a bit of varus on the leg that was shorter and display some valgus on the leg that was taller. I still walk normally but I am really intune with my structure when training and can tell.

This can cause some torque and stretching on the knee ligaments thus affecting biomechanics which can lead to muscle imbalances which could lead to joint subluxations as I mentioned earlier.

So how do you handle this: Doing things like unilateral training, and being very cautious of your exercise and lifting form as the body is a fine-tuned machine when it comes to precision and subtle movements.

This might only apply to patients with a larger than 2cm discrepancy though as I believe that’s the cut-off before it’s seen as medically necessary.

So yeah guys, as you can see it’s pretty clear that limb lengthening can leave its mark on you long-term. 

Most of which are negligible especially if you’re aware of what they are and how to deal with them and also by picking a good and experienced surgeon and doing consistent, proper rehab are all keys to avoiding the bad problems long term.