Orthofix Femoral Lengthening Surgery: Indications and Concerns

Indications for Orthofix Femoral Lengthening Surgery

Hello Dr.
Chen, I have congenital developmental dysplasia of the left femur (the neck of the left femur is shorter), which has resulted in a structural leg length discrepancy, with my left leg being 4.2 cm shorter than my right leg.
In April of this year, I decided to undergo limb lengthening surgery.
I have been using an external fixator for two months now, adjusting it four times a day as instructed, with a total daily lengthening of 1 mm.
I have also been practicing bending my knee.
However, during my follow-up appointment in the sixth week (at which point I had lengthened approximately 2.3 cm), it was discovered that my femur had become misaligned, and I had to undergo an emergency realignment surgery.
After the realignment surgery, I experienced some additional complications.
Therefore, I would like to ask:
1.
The doctor mentioned that my muscles are too strong, which may have caused the misalignment of the femur during the lengthening process.
Is this a possibility, or could it be due to my incorrect method of practicing knee bending? I have been having a family member use their foot as a pivot to support my thigh while I practice bending my knee and increasing the range of motion.
I have four steel pins in the external fixator, positioned at the top of the femur and 6 cm above the knee.
2.
After the realignment surgery, the doctor added two more steel pins in the middle, but I have experienced significantly more discomfort since the surgery.
Before the realignment surgery, although I had a leg length discrepancy, I was able to stand with my feet together.
However, after the surgery, I feel intense soreness and pain in the hip area of my left femur when attempting the same position, and I can no longer perform that action.
What could be the reason for this?
3.
I would like to ask on behalf of my mother.
Currently, there is only external fixation for lengthening.
The doctor mentioned that after lengthening to a certain extent, I would need to wait about six weeks for the bone to consolidate.
However, during this period, there are no steel pins or extensions in the gap created by the lengthening (the X-ray shows an empty segment).
My mother wants to know if the bone can truly grow together in this manner.
What is the underlying principle? Since the attending physician seems to discourage patients from asking too many questions, we are unable to clarify much, so I am reaching out to you for assistance.
Thank you.

Niming, 30~39 year old female. Ask Date: 2023/06/17

Dr. Chen Yongxue reply Orthopedics

1.
The doctor said that my muscles are too strong, which caused the femur to become misaligned during the lengthening process.
Is this a possibility? Yes, it is possible.
2.
After the reduction surgery, the doctor added two more screws in the middle, but I have experienced significantly more discomfort since the surgery.
Before the reduction surgery, although I had a leg length discrepancy, I was able to stand with my feet together.
However, after the reduction surgery, I feel intense soreness and pain in the left hip area of the femur when attempting the same position, and I can no longer perform that action.
What could be the reason for this? It may be related to muscle stretching.
3.
I am asking for my mother.
Currently, she only has external fixation for lengthening.
The doctor mentioned that after lengthening to a certain extent, she needs to wait about six weeks for the bone to mature.
However, during this period, there are no screws or extensions in the gap created by the lengthening (the X-ray shows an empty segment).
My mother wants to know if the bone can really grow together in this situation.
What is the principle behind this? Yes, it can work because it is an external fixation, and the fixation method is applied externally.

Reply Date: 2023/06/17

More Info

Orthofix femoral lengthening surgery is a specialized procedure aimed at correcting limb length discrepancies, such as those caused by congenital conditions like developmental dysplasia of the femur. In your case, you have a structural leg length discrepancy of 4.2 cm due to a shorter left femoral neck. While this surgery can be effective, it also comes with its own set of challenges and considerations.

1. Muscle Strength and Bone Alignment: It is indeed possible for strong muscles to exert forces that affect bone alignment during the lengthening process. If the muscles are overly tight or strong, they may pull on the bone in a way that causes it to deviate from its intended path. Additionally, the technique used for knee flexion exercises is crucial. If the support provided by your family is not aligned correctly, it could lead to improper movement patterns that may exacerbate the issue. It is essential to follow a rehabilitation protocol that is tailored to your specific condition, ideally under the guidance of a physical therapist who specializes in post-operative care for limb lengthening.

2. Post-Operative Discomfort: The increased discomfort you are experiencing after the revision surgery could be due to several factors. The addition of more pins can increase irritation in the surrounding soft tissues, leading to pain. Furthermore, the realignment of the bone may have altered the mechanics of your hip and knee, resulting in discomfort as your body adjusts to the new alignment. It’s also possible that the muscles and connective tissues around the hip are still adapting to the changes, which can lead to temporary pain and weakness. If the pain persists or worsens, it is crucial to communicate this with your orthopedic surgeon, as they may need to adjust your rehabilitation plan or investigate further.

3. Bone Healing and Growth: The process of bone healing after lengthening involves a biological phenomenon known as distraction osteogenesis. When the bone is gradually lengthened, new bone tissue forms in the gap created by the distraction. This process relies on the body’s natural healing mechanisms, where osteoblasts (bone-forming cells) migrate into the gap and begin to produce new bone. The absence of additional hardware in the gap does not hinder this process; rather, it allows for the formation of new bone tissue in a controlled manner. The key is to maintain a stable environment for the bone to heal, which is why the external fixator is crucial during this phase. Your surgeon will monitor the healing process through regular X-rays to ensure that the bone is forming correctly.

In conclusion, while femoral lengthening surgery can significantly improve limb length discrepancies, it requires careful management of both the surgical and rehabilitation processes. It is essential to maintain open communication with your healthcare team, even if your primary surgeon seems less inclined to engage in dialogue. Consider seeking a second opinion or consulting with a physical therapist who specializes in post-operative care for more personalized guidance. This approach can help address your concerns and ensure that you are on the right path to recovery.

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