Limb Length Discrepancy: Surgical Options and Risks

Leg length discrepancy?

Hello, Doctor.
I don't know why, but since childhood, my left knee has been growing outward.
I had surgery to correct it during my freshman year, but the leg length discrepancy did not improve.
As a result, my pelvis is also tilted, causing a lot of inconvenience due to the leg length difference.
Recently, I've even experienced sudden cramps in my back.
Today, I visited a specialist for orthotic insoles, and they informed me that my left leg is approximately 3 centimeters shorter than my right leg.
However, I don't want to wear orthotic insoles for the rest of my life; I want to wear regular shoes and walk normally.
I've heard about a technique called limb lengthening.
Would you recommend this surgery? However, I've also heard that there are many risks involved.

Xiao Qing, 20~29 year old female. Ask Date: 2017/05/06

Dr. Shi Guozheng reply Orthopedics

It is a limb lengthening surgery, but first, a scanogram X-ray is required to determine the difference in length between the two legs before deciding whether surgery is necessary.
The procedure carries certain risks.

Reply Date: 2017/05/06

More Info

Limb length discrepancy (LLD) can significantly impact a person's quality of life, leading to discomfort, functional limitations, and even psychological distress. In your case, it seems that you have been dealing with this issue for a long time, and the corrective surgery you underwent did not yield the desired results. The fact that you are experiencing pelvic tilt and back pain suggests that the discrepancy may be affecting your overall biomechanics, which can lead to further complications if left unaddressed.

When considering surgical options for limb length discrepancy, one of the most common procedures is limb lengthening surgery. This technique involves the gradual distraction of the bone after an osteotomy (cutting the bone). The Ilizarov technique and the more recent PRECICE nail system are popular methods used for this purpose. The Ilizarov method uses an external fixator, while the PRECICE system employs an internal device that can be adjusted non-invasively.

Surgical Options:
1. Ilizarov Technique: This involves placing an external fixator on the limb, which allows for gradual lengthening of the bone over time. The process typically takes several months and requires careful monitoring and rehabilitation.

2. PRECICE Nail: This is an internal device that is inserted into the bone and can be lengthened using a magnetic mechanism. This method is less visible and may offer a more comfortable recovery compared to the external fixator.

Risks and Considerations:
While limb lengthening surgery can be effective, it is not without risks. Some of the potential complications include:
- Infection: Both external and internal fixation methods carry a risk of infection, particularly at the surgical site.

- Nerve and Blood Vessel Damage: There is a risk of damaging surrounding nerves and blood vessels during the procedure, which can lead to complications such as numbness or circulatory issues.

- Nonunion or Malunion: Sometimes, the bone may not heal properly, leading to further complications that may require additional surgeries.

- Joint Stiffness: Post-operative stiffness in the joints can occur, necessitating physical therapy and rehabilitation.

- Psychological Impact: The lengthy recovery process and the physical changes can also have psychological effects, which should be considered.

Decision-Making:
Given your history of previous surgeries and the complications you've faced, it is crucial to have a thorough discussion with an orthopedic surgeon who specializes in limb lengthening. They can provide a detailed assessment of your specific situation, including the degree of discrepancy, your overall health, and your goals for surgery.
It is also essential to weigh the potential benefits against the risks. If the discrepancy is causing significant functional limitations or pain, and conservative measures (like orthotics) are not providing relief, surgical intervention may be warranted. However, if the risks seem to outweigh the benefits, you may want to explore other options, such as continued physical therapy, pain management strategies, or the use of custom orthotics.

In conclusion, while limb lengthening surgery can provide a solution for limb length discrepancy, it is essential to approach this decision carefully, considering all potential risks and benefits. Consulting with a qualified orthopedic specialist will help you make an informed choice that aligns with your health needs and lifestyle goals.

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