Congenital Limb Length Discrepancy and Surgical Options

Congenital limb length discrepancy, with the left calf noticeably more curved than the right?

Hello, I am 27 years old.
I have a congenital leg length discrepancy, with my right leg being approximately 5-6 cm shorter than my left.
I underwent examinations as a child, which revealed that it was due to congenital hip dislocation, causing the right femur to protrude, and there is also a height difference in my pelvis.
Additionally, my right leg exhibits symptoms of genu varum (bowlegs), making the asymmetry between my legs quite noticeable when standing, with my right leg being significantly curved.
Regardless of whether I stand for long periods or walk a lot, I experience pain in my right femur and cannot engage in prolonged physical activity.
I would like to know if I can undergo surgery now, what the risks are, and approximately how long it would take to recover if I do have the surgery.
Thank you, doctor!

kass, 20~29 year old female. Ask Date: 2018/03/28

Dr. Shi Guozheng reply Orthopedics

If there is a dislocation of the left hip joint accompanied by pain symptoms and medication treatment is ineffective, a total hip arthroplasty on the left side may be considered.
If the dislocation is not severe and there are no pain symptoms, then consideration can be given to whether limb lengthening surgery is appropriate.
The decision to proceed with surgery, as well as the associated risks and recovery period, must be thoroughly evaluated by a physician before making a determination.

Reply Date: 2018/03/28

More Info

Congenital limb length discrepancy (LLD) is a condition where one limb is shorter than the other, which can lead to various functional and aesthetic issues. In your case, you have a significant discrepancy of 5-6 cm between your legs, compounded by complications such as hip dysplasia and bowing of the right leg (O-shaped legs). These factors can contribute to pain, difficulty in mobility, and a decreased quality of life.

Surgical Options
There are several surgical options available for treating congenital limb length discrepancies, particularly when the difference is significant. The most common procedures include:
1. Limb Lengthening Surgery: This involves cutting the bone (osteotomy) and using an external fixator or internal device to gradually lengthen the bone over time. This method can be effective for correcting significant discrepancies, but it requires a lengthy rehabilitation process.

2. Epiphysiodesis: This procedure involves fusing the growth plate of the longer limb to stop its growth, allowing the shorter limb to catch up. However, this is typically only an option for children or adolescents whose growth plates have not yet closed.

3. Bone Grafting: In some cases, bone grafts can be used to fill in gaps or to stabilize the limb after lengthening procedures.

4. Corrective Osteotomy: This is particularly relevant for your case, as it can address both the length discrepancy and the deformity (O-shaped legs). The surgeon can realign the bones and correct the angle of the leg.

Risks of Surgery
As with any surgical procedure, there are inherent risks involved, including:
- Infection: Surgical sites can become infected, particularly with procedures involving external fixators.

- Nerve or Blood Vessel Damage: There is a risk of damaging nearby nerves or blood vessels during surgery.

- Nonunion or Malunion: The bones may not heal properly, leading to further complications.

- Pain and Stiffness: Post-operative pain is common, and some patients may experience stiffness in the joint.

- Psychological Impact: The aesthetic outcomes and the lengthy recovery process can also affect mental health.

Recovery Time
The recovery time can vary significantly based on the specific procedure performed, your overall health, and adherence to rehabilitation protocols. Generally, for limb lengthening surgery, the process can take several months to over a year, including:
- Initial Recovery: 4-6 weeks for the surgical site to heal.

- Lengthening Phase: This can take several months, during which the bone is gradually lengthened.

- Consolidation Phase: After the desired length is achieved, it takes additional time for the bone to heal and consolidate.

In total, you might expect a recovery period ranging from 6 months to over a year, depending on the complexity of your case and your body’s response to the surgery.

Conclusion
Given your age and the severity of your condition, it is advisable to consult with an orthopedic surgeon who specializes in limb length discrepancies. They can provide a thorough evaluation, discuss the most appropriate surgical options for your specific situation, and help you understand the risks and benefits involved. Additionally, they can outline a detailed rehabilitation plan to optimize your recovery and functional outcomes.
It’s essential to weigh the potential benefits of surgery against the risks and recovery time, and to consider how these factors align with your lifestyle and personal goals.

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