• Dr. Yuksel Yurttas

Choosing The Right Lengthening Strategy: Femur Lengthening vs Tibia Lengthening

If you want to have cosmetic limb lengthening surgery, you need to make some critical decisions before starting on this life-changing journey. Choosing the suitable method, the right surgeon, and the right bone segment comes first among these decisions. In this article, we will discuss the differences between femur lengthening and tibia lengthening, the amount of lengthening that can be achieved in each bone segment and the recovery times of procedures. In addition, we will help you make the right decision in choosing the bone segment and method according to different expectations.

Advanced limb lengthening methods and the amount of lengthening they provide

Precice Stryde and Precice 2.2

Precice Stryde (Stryde Nail) and Precice 2.2 (P2.2) are fully internal limb lengthening methods. Precice nails are produced by the US-based company Nuvasive and can only be used by qualified surgeons worldwide.

The common feature of Stryde and P2.2 nails is that they provide the same amount of lengthening in the femur and tibia. In both methods, patients can gain height up to 6 cm in the tibia and 8 cm in the femur.

The main difference between these two methods is that Stryde nails are made of stainless steel alloy and can bear the patient's entire body weight. On the other hand, Precice 2 nails are made of titanium allo and cannot bear the patien’t full body weight. For this reason, patients are mobilized with a wheelchair during the lengthening phase.

LON Method

LON method is the most accessible advanced limb lengthening method with its safe and comfortable lengthening experience at an affordable price. In the LON limb lengthening system, internal nails made of stainless steel alloy and external fixators are used together. Thus, patients can perform many physical activities, including walking, even during the lengthening phase.

With the LON method, patients can gain height up to 6 cm in the tibia or 8 cm in the femur. Unlike the Precice 2.2 and Stryde nails, the LON limb lengthening mechanism allows for a greater height increase (1 to 2 cm) than the above limits. However, the determining factor in the amount of lengthening is the ability of the patient's muscles, nerves and tissues to adapt to the new height.

Femur lengthening vs Tibia lengthening

Leg lengthening surgery is performed in the lower leg (tibia) and-or upper leg (femur). Both bone segments offer some conveniences and challenges to patients.

Femur Lengthening

The femur is the longest and strongest bone in the human body. The femur extends from the hip joint to the knee joint and plays a crucial role in standing and moving ability. Also, the femur supports many vital muscles, tendons, and ligaments of your circulatory system.

Femur lengthening is done by surgically cutting the femur and inserting a device that separates the two ends of the bone by a certain amount each day. As the space opens between these two ends, the body uses its natural ability to create new bone tissue to fill the space.

The advantages of femur lengthening

  • Femur heals faster than the tibia

  • Femur lengthening provides greater height gain than tibia lengthening

  • Femur lengthening has fewer possible risks and complications than tibia lengthening

The disadvantages of femur lengthening

  • Femur lengthening is more painful in the first weeks after surgery than tibia lengthening.

Tibia Lengthening

The tibia is the larger, stronger, and anterior (frontal) of the two bones in the leg below the knee (the other being the fibula, behind the tibia) and connects the knee to the ankle.

Tibia lengthening is done by surgically cutting the tibia and fibula and inserting a device that separates the two ends of the tibia bone by a certain amount (1mm/day) each day.

The advantages of tibia lengthening

  • Tibia lengthening is less painful than femur lengthening, and the patient's mobility is greater during the lengthening.

  • Bowlegs (genu varum) can be corrected with tibia lengthening surgery

The disadvantages of tibia lengthening

  • Tibia heals slower than the femur

  • The limiting factor in tibia lengthening is the Achilles tendon in the lower leg. If the lengthened tibia becomes longer than the stretching limits of the Achilles tendon, your heels may not be able to touch the ground until the Achilles tendon is sufficiently stretched. This condition can usually improve within a few months with physiotherapy and exercise.

  • The Achilles tendon can be lengthened for greater tibial lengthening. Surgical lengthening of the Achilles tendon can lead to permanent muscle weakness. For this reason, we do not recommend lengthening the Achilles tendon to allow greater lengthening.

Lengthening Strategies

Option 1 – Bilateral Femur Lengthening

Max. lengthening amount: 8 cm / 3.25 inches

If you want maximum height gain with a single procedure, you should have femur lengthening surgery.

Option 2 – Bilateral Tibia Lengthening

Max. lengthening amount: 6 cm / 2.35 inches

If your tibia is shorter than your femur and you think longer lower legs will look more proportional, or 5-6 cm height gain is enough for you, you should have tibia lengthening surgery.

Option 3 – Femur Lengthening after completion of Tibia Lengthening

Max. lengthening amount: 14 cm (6 cm / 2.35 inches + 8 cm / 3.25 inches)

If you are determined to have two lengthening surgeries, you should first have tibia lengthening and then femur lengthening. Thus, your tibia bone heals while your femur is lengthened.

Option 4 – Tibia Lengthening after completion of Femur Lengthening

Max. lengthening amount: (14 cm) 8 cm / 3.25 inches + 6 cm / 2.35 inches

If you are undecided about whether to have a second lengthening surgery or if you do not have time to have a second surgery right away, you should first have Femur lengthening and then tibia lengthening to achieve maximum height gain.

Is it possible to simultaneously lengthen the tibia and femur? (Quadrilateral Limb Lengthening Surgery)

It is theoretically and practically possible to simultaneously extend the tibia and femur bone at the same time. However, this option increases the risks of surgery (fat embolism) and provides a more painful and uncomfortable leg-lengthening experience for patients. Dr.Yuksel Yurttas prioritizes patient safety and implements limb lengthening procedures by minimizing risks. Therefore, he does not perform quadrilateral limb lengthening surgery and does not recommend it to his patients.

Nicolas is one of our patients who first had tibia lengthening surgery and then had femur lengthening surgery after the lengthening was completed.

I am still undecided about which bone segment to choose for lengthening. What should I do?

Before limb lengthening surgery, we undergo a series of tests and examinations. One of these tests is the Ortho X-ray, which gives precise anatomical tibia and femur lengths. You can decide the most proportional lengthening strategy for you with your surgeon after you have this test done.

You can also book a free consultation and get support from us in choosing the right limb lengthening strategy for you.

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