Risk and Complications

Most of the complications are avoided by good following up

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

Slow or rapid bone healing
Muscle and joint complications
Osteomyelitis (bone infection)
Nerve and blood vessel injury
Pin loosening (LON and external methods)
Pin site infection (LON and external methods)
Postoperative swelling
Pain and sleeping difficulties
Psychological impact

Let’s examine the risks and complications of limb lengthening surgery in more detail.

1. Slow or Rapid Bone Healing

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

a. Rapid bone healing

Some people may experience faster bone healing which is a biological reaction specific to that person and 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. However, if the bone union has already occurred due to rapid bone healing, an additional surgical procedure may be required for correction.

b. Slow bone healing

In some patients, new bone may not form as quickly as it should. 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 may decide to reduce the daily lengthening amount, resulting in treatment taking longer than expected.

c. Nonunion

In rare cases, the bone union may not occur, a condition known as nonunion. In such cases, the doctor may decide to stop the lengthening procedure, reverse it, or perform an additional surgical procedure to correct the issue.

2. Muscle and Joint Complications

During limb lengthening procedures, it is important for muscle adaptation to keep pace with the bone extension. A mismatch of bone and muscle length can negatively affect the mobility of the leg and result in postoperative complications such as muscle contractures and joint stiffness.

a. Muscle contractures

These occur when the muscles do not adapt to the bone extension, causing pain and difficulty in movement. To prevent muscle contractures, patients should follow a regular exercise program and receive physiotherapy sessions.

b. Joint stiffness and contractures

These occur when muscles become too tight, pulling on the surrounding joints and causing difficulty in joint mobility. To prevent and treat joint stiffness and contractures, patients should follow a regular exercise program and receive physiotherapy sessions. In rare cases, surgical intervention may be necessary to correct joint stiffness or contractures. It is important to note that early physical therapy intervention can help in preventing muscle and joint contractures.

3. Osteomyelitis (bone infection)

Osteomyelitis, also known as bone infection, is a potential complication that can occur following limb lengthening surgery, particularly in methods that involve external fixation. To prevent osteomyelitis, patients should maintain proper hygiene, follow post-operative care instructions and avoid exposing the surgical site to dirt or bacteria.

Additionally, regular needle site dressings and bandage changes can also help minimize the risk of infection. If osteomyelitis is detected, it can be treated with antibiotics and pain relievers in the early stages, but surgical intervention may be necessary in some cases.

4. Nerve and Blood Vessel Injury

During limb lengthening procedures that involve external fixation, there is a small risk of injury to nerves and blood vessels. This can occur due to the insertion of pins and wires into the bone, which may compress or damage surrounding nerves and blood vessels.

a. Nerve injuries

Nerve injuries can result in temporary or permanent loss of sensation or movement. Treatment for nerve injuries may include physical therapy, nerve stimulation, and in some cases, surgical intervention.

b. Blood vessel injuries

Blood vessel injuries can cause blood loss and may require surgical repair in severe cases. These injuries are rare but it is important to be aware of the potential risks and to seek medical attention immediately if any symptoms occur.

5. Pin loosening (Methods with External Fixation)

In limb lengthening methods that require external fixation, such as the LON method, pin loosening is a possible complication that can occur due to various technical factors. These factors may include improper insertion technique, frame stiffness, and poor anchorage. Pin loosening can compromise the stability of the fixation and may require additional surgical intervention to correct. It is important to note that pin loosening is not a common complication and can be minimized by following proper post-operative care instructions and closely monitoring the fixation during the healing process.

Pin Site Infection (Methods with External Fixation)

Pin site infections can happen during limb lengthening procedures that use external fixation like the LON method. These infections can be caused by bacteria at the surgical site, poor dressing changes, or other issues. They can cause pain, slow healing, and other problems. To prevent pin site infections, it’s important to keep the surgical site clean, follow post-operative care instructions, and monitor the surgical site closely. Treatment might include antibiotics, wound care, and surgery in some cases. On the other hand, the Precice 2 method does not have this risk because it is fully internal and does not use external fixation.

7. Postoperative swelling

Postoperative swelling is a normal response to surgery and is caused by the accumulation of fluid in the affected area. It is a common complication after limb lengthening surgery and can cause discomfort, pain, and difficulty in movement. The swelling can also impede the healing process and delay recovery time. To manage postoperative swelling, patients are typically prescribed medication, such as non-steroidal anti-inflammatory drugs (NSAIDs) and compression garments, and undergo physical therapy to help reduce inflammation and improve circulation. Physical therapy exercises can also help to improve the range of motion and prevent stiffness in the affected limb. In some cases, the surgeon may also use a technique called intermittent pneumatic compression to help reduce swelling and promote healing. Additionally, elevation of the affected limb, and keeping the limb active can also help in reducing the swelling

8. Pain and Sleeping Difficulties

Pain is a common experience for patients undergoing limb lengthening procedures and can range from mild discomfort to severe pain. Pain is typically highest in the days immediately following surgery and gradually decreases over time with proper management and pain control. However, pain tolerance and sensitivity can vary greatly among patients, and some may experience difficulty sleeping due to pain.

The healthcare team and surgeon will work closely with patients to manage pain and ensure that treatment protocols are tailored to each individual’s needs. This may include a combination of medication, physiotherapy, and other pain management techniques. It is important for patients to report any pain or sleeping difficulties they are experiencing to their healthcare team so that appropriate action can be taken to alleviate symptoms.

9. Psychological impact

Undergoing limb lengthening surgery can be a significant emotional and physical journey. It’s important to have realistic expectations and to be prepared for the process, including the treatment period and recovery time. While the procedure can have life-changing benefits, it’s important to keep in mind that there may also be potential emotional challenges to consider.