Short and Long Legs: Risks of Surgery and Aftermath

Q: Short and Long Legs: Risks of Surgery and Aftermath

Hello： In response to your question... <br>the frightening sequelae... <br>mainly include several points： 1. <br>Nerve injury： The most concerning issue with limb lengthening is the potential for nerve injury due to the stretching of nerves. <br>If the limb is lengthened but ther

Leg length discrepancy?

Hello, Dr.
Lee! Thank you very much for your response to my previous question.
However, you mentioned that due to my history of osteomyelitis, you personally do not recommend surgical intervention (does this mean my life is over?).
You indicated that the risk of reinfection or complications is very high.
I understand a bit about the issue of reinfection, but I am not aware of what complications could arise.
Could you please explain what serious complications I might face? Additionally, I remember that during my hospitalization, I received third-generation antibiotics.
If I were to undergo surgery, would there still be antibiotics available that could effectively target the bacteria? Thank you once again for your response, Dr.
Lee! I am truly grateful.

A-Ding, 20~29 year old female. Ask Date: 2004/10/25

Dr. Li Wenlin reply Orthopedics

Hello: In response to your question...
the frightening sequelae...
mainly include several points: 1.
Nerve injury: The most concerning issue with limb lengthening is the potential for nerve injury due to the stretching of nerves.
If the limb is lengthened but there is no sensation or movement, it can result in a non-functional limb, rendering the lengthening meaningless.
2.
Infection: There is also a possibility of recurrent osteomyelitis.
Generally, if the cultured bacteria are not highly resistant, treatment with antibiotics and hyperbaric oxygen therapy can be effective.
However, if the strain is resistant to vancomycin, there may be no available antibiotics for treatment.
3.
Muscle and soft tissue degeneration: Lengthening surgery can also lead to muscle degeneration, resulting in loss of elasticity and fibrotic stiffness.
Consequently, the limb may be lengthened but lack the necessary elasticity and function.
There may be significant discrepancies in size, and there are other potential sequelae, but the three mentioned above are the most severe.
Keelung Hospital, Department of Health Li Wen-Lin

Reply Date: 2004/10/25

More Info

When considering surgical options for addressing leg length discrepancies, particularly in the context of previous medical history such as osteomyelitis (bone infection), it is crucial to weigh the potential risks and benefits carefully. Surgical interventions like limb lengthening can offer significant improvements in function and quality of life, but they also come with inherent risks, especially for individuals with a history of infections.

Risks of Surgery
1. Infection: One of the most significant risks associated with any surgical procedure, particularly in patients with a history of osteomyelitis, is the potential for postoperative infections. The presence of previous infections can complicate healing and increase the likelihood of recurrent infections. If an infection occurs post-surgery, it can lead to severe complications, including the need for additional surgeries, prolonged antibiotic treatment, or even amputation in extreme cases.

2. Nerve Damage: Surgical procedures, especially those involving bone lengthening, carry the risk of nerve injury. This can result in numbness, weakness, or loss of function in the affected limb. While surgeons take precautions to avoid nerve damage, the risk cannot be entirely eliminated.

3. Delayed Healing: Patients with a history of infections may experience delayed healing due to compromised blood flow or other factors. This can prolong recovery time and increase the risk of complications.

4. Joint Problems: Lengthening a limb can alter the biomechanics of the joint, potentially leading to issues such as joint instability or arthritis over time. This is particularly relevant if the leg length discrepancy is significant.

5. Psychological Impact: The emotional and psychological toll of undergoing multiple surgeries and dealing with chronic pain or functional limitations can be profound. Patients may experience anxiety or depression related to their condition and the surgical outcomes.

Aftermath and Long-term Considerations
1. Rehabilitation: Post-surgical rehabilitation is critical for recovery. Physical therapy is often required to regain strength and mobility. Patients may need to engage in extensive rehabilitation to adapt to changes in limb length and function.

2. Monitoring for Complications: After surgery, patients must be closely monitored for signs of complications, including infection, nonunion (failure of the bone to heal), or malalignment of the limb. Regular follow-up appointments with the orthopedic surgeon are essential.

3. Antibiotic Use: In the context of your previous antibiotic treatment, it is essential to discuss with your surgeon the appropriate use of antibiotics during and after surgery. Prophylactic antibiotics may be administered to prevent infections, especially in patients with a history of osteomyelitis. The choice of antibiotics will depend on the specific bacteria involved in your previous infections and the surgical procedure being performed.

4. Quality of Life: While surgery can improve physical function and reduce the impact of leg length discrepancies, it is essential to have realistic expectations. The goal of surgery should be to enhance quality of life, but outcomes can vary significantly among individuals.

Conclusion
In summary, while limb lengthening surgery can provide significant benefits, it is not without risks, particularly for individuals with a history of infections like osteomyelitis. It is crucial to have thorough discussions with your orthopedic surgeon about your specific case, including the risks of surgery, potential complications, and the rehabilitation process. Seeking a second opinion from another orthopedic specialist may also provide additional insights and help you make an informed decision about your treatment options. Ultimately, the decision to proceed with surgery should be made collaboratively, considering both the potential benefits and the risks involved.

Similar Q&A

Understanding Limb Length Discrepancy: Surgical Options and Risks

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 ...

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.

Post-Operative Hip Replacement: Addressing Nerve Pain and Recovery Concerns

After the mother underwent left total hip arthroplasty, she experienced numbness and pain on the outer side of her lower leg, and she is unable to dorsiflex her foot, although she can plantarflex and move her toes. The attending physician indicated that this might be due to a blo...

Dr. Shi Guozheng reply Orthopedics
1. It is possible that the sciatic nerve is being compressed, which can lead to an inability to dorsiflex the ankle joint. If the compression is not severe, recovery is possible. Currently, one option is to use a splint to maintain the ankle joint at a 90-degree angle. 2. After...

Understanding Back Area Obstacles: Treatment Options and Risks

Hello, Doctor. I have been struggling with a left leg impairment (resulting in muscle atrophy, with my left calf being approximately 2 cm smaller than my right calf, and I am unable to fully extend or bend my left toes). It was quite severe when I was younger, to the point where ...

Dr. Shi Guozheng reply Orthopedics
The limitation in the extension of your left leg may refer to the inability of the knee joint to fully straighten. Since you are now an adult, the effectiveness of tendon release surgery is generally less favorable compared to childhood, which is why the experts at National Taiwa...

Post-HIVD Surgery Complications: Understanding Leg Length Discrepancy and Pain

Hello Dr. Wang, I apologize for missing a few questions. I'm sorry. 1. I did not have a leg length discrepancy issue before, but after my second surgery, my right leg became longer. The orthopedic and neurosurgeons said this was due to my foot not being able to bear weigh...

Dr. Wang Shouji reply Orthopedics
Hsieh: Spinal surgery does not cause leg length discrepancies. The sensation of having one leg shorter than the other is often due to limping, pain avoidance, or muscle weakness gait. Back pain or deformities that cause pelvic tilt can also be easily misinterpreted as leg length ...