Functional recovery of daily living and sports activities after cosmetic bilateral tibia lengthening

Trends and Practices in Limb Lengthening: An 11-year US Database Study

Aim

Over the past couple of decades, limb lengthening has evolved to encompass various implants and techniques. The purpose of this study was to (1) determine trends in the utilisation of various limb lengthening techniques for the femur and tibia in the United States, (2) determine trends in 1-year readmission rate following limb lengthening procedures and (3) to study the relationship of limb lengthening implant used and payment method used with the underlying diagnosis associated with limb shortening.

Materials and methods

Inpatient data were acquired using the Healthcare Cost and Utilisation Project (HCUP) database from 2005 to 2015 from seven states in the United States. Patients with an International Classification of Diseases (ICD)-9 code for limb lengthening of the femur or tibia were included. A total of 2,563 patients were included. Data were analysed using descriptive statistics, and chi-square test was used for comparison of subcategories. Linear regression analysis was used to examine trends over time.

Results

There was a strong linear trend towards increasing proportional use of internal lengthening of the femur from 2011 to 2015 (R2 = 0.99) with an increase of 10.2% per year. A similar trend towards increasing proportional use of internal lengthening of the tibia was seen from 2011 to 2015 (R2 = 0.87) with an increase of 4.9% per year. There was a moderate correlation showing a decrease in readmission rate of 1.07% per year from 2005 to 2015 (R2 = 0.55). Patients with short stature had increased use of internal lengthening and self-payment compared to patients with congenital, post-traumatic or other diagnoses.

Conclusion

There was increasing use of internal lengthening techniques from 2011 to 2015. Patients with short stature had higher use of internal lengthening technique and self-pay for payment method.

Clinical significance

Intramedullary devices have seen increasing use for limb lengthening procedures. Lengthening technique and payment method may differ by underlying diagnosis.

How to cite this article

Mittal A, Allahabadi S, Jayaram R, et al. Trends and Practices in Limb Lengthening: An 11-year US Database Study. Strategies Trauma Limb Reconstr 2023;18(1):21-31.

Cosmetic stature lengthening: systematic review of outcomes and complications

Aims

To systematically review the outcomes and complications of cosmetic stature lengthening.

Methods

PubMed and Embase were searched on 10 November 2019 by three reviewers independently, and all relevant studies in English published up to that date were considered based on predetermined inclusion/exclusion criteria. The search was done using “cosmetic lengthening” and “stature lengthening” as key terms. The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles.

Results

A total of 11 studies including 795 patients were included. The techniques used in the majority of the patients were classic 3- or 4-ring Ilizarov fixator (267 patients; 33.6%) and lengthening over nail (LON) (253 patients; 31.8%), while implantable lengthening nail (ILN) was used in the smallest number of patients (63 patients; 7.9%). Mean end lengthening achieved was 6.7 cm (SD 0.6; 1.5 to 13.0), and the mean follow-up duration was 4.9 years (SD 2.1; 41 days to 7 years). Overall, the mean number of problems, obstacles, and complications per patient was 0.78 (SD 0.5), 0.94 (SD 1.0), and 0.15 (SD 0.2), respectively. The most common problem and obstacle was ankle equinus deformity, while the most common complications were deformation of the regenerate after end of treatment and subtalar joint stiffness/deformity.

Conclusion

Cosmetic stature lengthening provides favourable height gain, patient satisfaction, and functional outcomes, with low rate of major complications. Clear indications, contraindications, and guidelines for cosmetic stature lengthening are needed.

Cite this article: Bone Joint Res 2020;9(7):341–350.

Excessive Aesthetic Lower Limb Elongation Management

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With the evolution of surgical techniques and increased availability of cosmetic orthopedic surgery, new complications manifest. Uncontrolled lower limb elongation without limitations can be achieved by disinformation and undergoing surgery in different countries. Patients receive excessive surgical intervention due to misinforming surgeons and clinics of their previous medical history. We present a previously undocumented case of excessive lower limb elongation in an adult male patient and a treatment method for this novel pathology. Lack of personal constraint and severe aesthetic discomfort led the patient to undergo 3 elongation procedures in 3 clinics in different countries. Correction of excessive elongation is a delicate procedure, which must account for previous medical history, the patient’s psychological status, and strict adherence to anatomical standards. In this case, we managed to correct the complications from hyper-elongation by restoring the normal anatomical proportions of the lower limbs. The patient consented to publication of these findings and has undergone psychiatric evaluation in a specialized clinic after corrective surgery. It is important to properly educate patients of surgical risks and to evaluate all aspects of patient psychosomatic well-being before surgical intervention. Advances in aesthetic medicine underline the development of new iatrogenic pathologies. Excessive lower limb elongation can lead to significant musculoskeletal deformation, requiring precise surgical correction with account to normal anatomical proportions.