• Dr. Yuksel Yurttas

Limb Lengthening Surgery: Risks, Complications, and Side Effects

As with any surgical procedure, limb lengthening surgery can cause some difficulties. In this article, we examined the possible risks, complications, and side effects of limb lengthening surgery in detail.


Limb lengthening begins with an operation known as an osteotomy, in which the orthopedic surgeon cuts the bone to be lengthened. The surgeon then fixes the bones with an external fixator and-or an internal nail. After the surgery, the cut bone is opened at certain intervals every day. As a result, the body renews itself and fills this gap with new bone tissue.


Limb lengthening is an operation on the main leg bones that carry the body. Therefore, it carries various risks and requires special care and attention throughout the treatment.


Possible risks, complications, and side effects of limb lengthening surgery include:

  1. Slow or rapid bone healing

  2. Muscle contractures

  3. Osteomyelitis (bone infection)

  4. Nerve and blood vessel injury

  5. Joint stiffness and contractures

  6. Pin loosening (LON and external methods)

  7. Pin site infection (LON and external methods)

  8. Pain and sleeping difficulty

Now let's take a closer look at all this.


1. Slow or rapid bone healing


Limb lengthening procedures are processes of formation and healing of new bone. In some cases, the bone may heal too quickly or too slowly. The healthcare team regularly X-rays patients and monitors their progress to detect similar conditions beforehand.

a. Rapid bone healing


Some people experience faster bone healing. This situation is a biological reaction specific to that person. It is not caused by any negligence or misapplication of the procedure. If rapid bone healing is observed during the lengthening phase, the doctor may increase the daily lengthening amount to stabilize the process. If the bone union has occurred due to rapid bone healing, an additional surgical procedure may be required for correction.


b. Slow bone healing


New bone does not form as quickly as it should in some patients. This is one of the complications that can be detected by x-ray during the lengthening phase and can be overcome by intervention. In such cases, the doctor decides to reduce the amount of daily extension. Therefore, treatment may take longer than expected.


c. Nonunion


In some cases, the bone union does not occur. The condition in which the bone does not heal is called nonunion. In such cases, the doctor may stop the lengthening procedure, reverse it, or decide on an additional surgical procedure. However, nonunion is very rare.


2. Muscle contractures


During leg-lengthening, muscle adaptation must keep up with the bone extension. Otherwise, A mismatch of bone and muscle length will negatively affect the mobility of the leg and thus the postoperative outcome. To avoid this complication, which also causes pain, patients should exercise regularly and receive physiotherapy sessions.


3. Osteomyelitis (bone infection)


Osteomyelitis, also known as bone infection, is one of the complications that can occur for various reasons after limb lengthening surgery.


Bone infection can occur by diffusion into the bloodstream or nearby soft tissue due to an exposed wound or any cause that affects the immune system. Osteomyelitis is more common in lengthening methods requiring external fixation and regular dressing. However, it can also be seen in patients who have undergone lengthening surgery with internal procedures.


A physical exam, blood tests, imaging studies, or rarely a bone sample is used to detect the risk of osteomyelitis early. However, it is also possible to avoid this complication and minimize the risk in most cases, with regular pin site dressing in the external and LON limb lengthening method.

In the case of osteomyelitis, the healthcare team and doctor will follow up with the patient closely. The patient can be treated with antibiotics and pain relievers in the early stages of the complication. However, surgical intervention may be needed to get over osteomyelitis in rare cases.


4. Nerve and blood vessel injury


In the external and combined method, the surgeon's fixator blocks the nerves and blood vessels and uses needles and wires to attach them to the bone. However, there is a very rare risk of damage to a nerve or blood vessel during the procedure.


Nerve injuries can cause temporary or permanent loss of sensation or movement. In these cases where recovery is slow, the patient may need further surgery.


In blood vessel injuries, blood loss may occur depending on the severity of the injury. But if a large blood vessel is damaged, the patient may need surgery to repair it.


5. Joint stiffness and contractures


In a limb lengthening procedure, the muscles that extend along with the bone may become tense, stiff, and sore during the lengthening phase. This situation can cause difficulty in joint mobility. If a muscle becomes too tight and begins to pull on the surrounding joints, the joint may become stiff or even start to dislocate.


In such cases, the surgeon may slow or stop treatment from getting the joint moving again. In rare cases, the patient may need surgical intervention.


It is also necessary to exercise regularly and receive physiotherapy sessions to prevent and treat joint stiffness and contractures.


6. Pin loosening (LON and external methods)


In limb lengthening methods that require external fixation, pin loosening may occur in pin placement anchorage areas due to technical factors. Insertion technique and frame stiffness are some causes of pin loosening. As with all complications, our surgeon and healthcare team take the risk of pin loosening seriously. In such cases, The doctor implements the necessary protocol to resolve this issue.

LON method limb lengthening pin sites
Regular pin sites dressing minimizes the risk of possible complications in external and LON method limb lengthening procedures.

7. Pin site infection (LON and external methods)


Pin site infections are a common complication of limb lengthening procedures that require external fixation. The main cause of pin site infections is inadequate needle site dressing changes and improper needle care procedures.


In such cases, the healthcare team closely monitors the infection. This complication can usually be treated with antibiotic drugs. However, It is also one of the complications that should be taken seriously as it can cause new scar formation or lead to osteomyelitis.


8. Pain and sleeping difficulty


Pain in limb lengthening procedures is a condition that every patient experiences at some time, from the first day after surgery to full recovery. Although the severity of the pain is high in the first days after the surgery, the pain becomes manageable within a week due to the implementation of a treatment protocol that includes the drugs to be used according to the severity of the pain.


Everyone feels pain in different levels and ways. Therefore, pain and pain threshold is very subjective. Some patients are pain resistant, while others are more sensitive. Besides, some patients may experience sleep difficulties due to pain in the first period after surgery. However, the healthcare team and the surgeon take your complaints seriously during your treatment and ensure that your complaint is resolved by applying the necessary treatment protocols in such cases.


What should be done to avoid possible risks, side effects, and complications?


Choosing surgeons who specialize in these limb lengthening and deformity correction procedures for your surgery is the first step you should take to avoid possible risks, side effects, and complications.


Before and after limb lengthening surgery, the surgeon and healthcare team inform patients about the lengthening and treatment process. Patients must learn every detail, follow the doctor's recommendations and implement the instructions carefully to avoid possible complications and risks.


In addition to the complications mentioned above, there is always a risk of experiencing different difficulties. For this reason, it is vital to follow the doctor's instructions during the treatment, take x-rays at regular intervals, and share every detail about your health condition with the healthcare team.


Dear patient candidates, you should choose the right surgeon for a smooth limb lengthening experience. In this article, you can find the best limb lengthening surgeons, their methods, and their costs from all over the world.


Dr. Yuksel Yurttas is the most experienced orthopedic surgeon specializing in limb lengthening surgery in Turkey and has performed over 600 successful surgeries in his 25 years of career. Besides, we have a highly trained healthcare team that will protect and inform you against any side effects you may experience during your treatment.


For further information and free personalized consultation, contact us via WhatsApp at +90 533 973 5289 or info@dryukselyurttas.com.