Leg lengthening and shortening

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REMOVAL OF IMPLANTED METAL DEVICES

Metal pins, screws, staples, or plates may be used to stabilize bone during healing. Most orthopedic surgeons prefer to wait several months to a year before removing any large metal implants. Removal of implanted devices requires another surgical procedure using general anesthesia.

Leg lengthening is considered for large differences in leg length (more than 5 cm or 2 inches). Leg lengthening is more likely to be recommended:

• For children whose bones are still growing
• For patients who were short to begin with

Leg shortening or restricting is considered for smaller differences (less than 5 cm or 2 inches). Shortening a longer leg may be recommended for children whose bones are no longer growing.

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Bone growth restriction is recommended for children whose bones are still growing. It is used to restrict the growth of a longer bone, while the shorter bone continues to grow to match its length. Proper timing of this treatment is important to ensure good results.

Medical illnesses that lead to severely unequal leg lengths include the following:

• Poliomyelitis and cerebral palsy
• Small, weak (atrophied) muscles or short, tight (spastic) muscles, which may cause deformities and prevent normal leg growth
• Hip diseases such as Legg-Perthes disease
• Previous injuries or bone fractures that may stimulate excessive bone growth
• Birth defects (congenital deformities) of bones, joints, muscles, tendons, or ligaments

After bone growth restriction:

• It is common for children to spend up to a week in the hospital. Sometimes a cast is placed on the leg for 3 to 4 weeks.
• Healing is complete in 8 to 12 weeks, at which time the child can restart full activities.

After bone shortening:

• It is common for children to spend 2 to 3 weeks in the hospital. Sometimes a cast is placed on the leg for 3 to 4 weeks.
• Muscle weakness is common, and muscle strengthening exercises are started soon after surgery.
• Crutches are used for 6 to 8 weeks.
• Some children take 6 to 12 weeks to regain normal knee control and function.
• A metal rod placed inside the bone is removed at 1 year.