Leg Length Discrepancy And Treatment Options

Leg Length Discrepancy And Treatment Options 2017-10-18T20:18:59+00:00

Limb length discrepancy (LLD) does not cause a problem for everyone who has it. When limb length discrepancy does cause limping or pain, or keeps you from participating in the activities you like, you have options.

Use the information on this page to start learning about treatment options and inform your conversation with a health care professional who specializes in limb length discrepancy.

“Now that I’ve had the surgery it’s just so much better. It’s changed my life.” – Lauryn Kapiloff

Your Guide to LLD Treatment Options

Determining the right treatment for limb length discrepancy can feel overwhelming. The information on this page is designed to help inform you about the treatment options available. Not all the information will apply to your individual treatment, and it is not meant to replace any personal conversations that you might wish to have with your physician or other member of your healthcare team.

A surgeon experienced in limb lengthening techniques can explain the treatment options, risks, and benefits in more detail – so it’s important to find a health care professional who specializes in limb length discrepancy to discuss whether surgical or non-surgical treatment is best for you.

What are the Risks of Limb Lengthening Surgery?

As with any surgery, there are some risks associated with limb lengthening, and it’s important to discuss these risks with your surgeon to determine whether limb lengthening is right for you. Possible complications include:

  • Blood clots – Patients are at risk for developing blood clots after orthopedic surgery, but there are measures in place at the hospital to help avoid this.
  • Nerve and blood vessel injury – In some instances, nerves and blood vessels can become damaged, either at the time of surgery or during the subsequent lengthening of the bone.
  • Infection – As with any surgery, there is a risk of infection. Since the PRECICE device is inserted inside your bone, the risk of infection is very low, approximately < 1%. If you have had a previous lengthening with an external fixator, the infection risk is slightly higher. Your surgeon can discuss this with you.
  • Joint stiffness and soft tissue tightness – As your bone is lengthened, your soft tissues also get stretched. Muscles become very tight, and it is recommended you maintain movement in your hips, knees, and ankles. Physical therapists can teach you exercises to help minimize stiffness.
  • Joint instability – Following long lengthening procedures, there is a small risk of dislocation of a nearby joint.
  • Delayed union – This may occur if the bone does not form during lengthening or takes a long time to consolidate. Other reasons for failure to gain length relate to problems with stretching the nerves, blood vessels, muscles, and tendons.
  • Refracture – Following removal of the device, there is a small risk of fractures in the lengthened bone. If this occurs, the limb might require another surgery or time in a cast or brace; therefore, it is important to follow your surgeon’s recommendations about physical activities.

While a small limb length discrepancy may not cause problems, a significant difference can cause a noticeable limp and may require treatment. Non-surgical treatment options include the “wait-and-see” approach for children who are still growing and the shoe lift for those with a difference of less than 5 cm.

Surgical treatment options are generally used for limb length discrepancies greater than 5 cm.

  • Bone growth restriction (epiphysiodesis, or growth arrest) is often successful when performed at the right time in adolescence, but it may cause short stature.
  • Bone shortening is more predictable than epiphysiodesis, but it has a much longer recovery period.
  • Leg lengthening surgery may allow patients to achieve their full height potential, but external fixators require continual maintenance. Internal fixators produce comparable results with fewer risks.

Some limb length discrepancies may require special treatment, but you and your surgeon can decide what treatment, if any, is best for you.
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Related Links:

1. Laubscher M, Mitchell C, Timms A, et al. Outcomes following femoral lengthening: An initial comparison of the PRECICE intramedullary lengthening nail and the LRS external fixator monorail system. Bone Joint J 2016;98-B:1382–8.

2. Landge V, Shabtai L, Gesheff M, et al. Patient satisfaction after limb lengthening with internal and external devices. J Surg Orthop Adv 2015;24(2):174-9.