Stature lengthening is a surgical procedure which can allow those who feel self-conscious about their height to increase their stature by lengthening the bones of the leg.
The procedure is ‘elective’, meaning that a person can choose to complete it for their own reasons, even though it may not be clinically necessary to do so. Often this can be due to negative ideas about their own appearance, or a desire to become taller in order to appear more attractive or fulfil a particular career goal.
What does stature lengthening involve?
Stature lengthening can only be carried out on adults who have already reached their maximum natural height and who have a good chance of achieving a full recovery after the operation. As part of your health assessment, Professor Al Muderis will recommend a treatment plan based on your current health status and your lengthening goals.
Growing your stature relies on a process known as distraction osteogenesis and is completed over period of several months. Full functional recovery can take up to a year, although the speed of recovery depends on a host of different factors, including how your body responds to the treatment and your ability to heal.
Lengthening is most commonly completed using a special telescopic nail which is inserted into the medullary canal of the bone that is going to be lengthened. These nails have largely replaced the use of older, unwieldy, external frames for cosmetic lengthening, as they come with a lower risk of infection and are associated with much less scarring.
Lengthening may be carried out on either the thigh bone (the femur) or the shin bone (the tibia), though not at the same time. The femur is one of the longest and strongest bones in the body, and it can be safely lengthened by up to 8cm. The tibia, alternatively, can be safely lengthened by around 5cm and is typically less painful, but heals slower than the femur. It is important, when deciding on the nature of your lengthening, to consider how the choice can affect your body proportions and their impact on your post-operative goals.
For femur lengthening, the nail is typically inserted through a small incision near the hip, and for tibial lengthening, it is normally inserted through a small incision at the upper part of the shin, close to the knee.
The bone is first prepared using specialised tools to ensure that the nail fits comfortably inside it. An osteotomy is then performed, which sees the target bone cut into two pieces, normally mid-way along its length. It is the eventual filling of this cut with new bone that enables the limb to grow.
Once the osteotomy is complete, the nail is inserted and aligned, then secured into place using locking screws at the top and bottom. This stops the nail from moving out of position during the lengthening process.
What happens after surgery?
Following your surgery, the bone is left for up to a week so that it can start to heal. This is known as the latency phase. This initial rest period is followed by the distraction phase, with which the process of lengthening begins.
During distraction, you will be provided with a special device, known as an External Remote Controller (ERC) device. When held against your leg it can be used to send a signal to the implanted nail which increases its length and thereby pushes apart (or ‘distracts’) the two halves of your bone.
This process is painless, and is normally completed at a rate of 1mm of lengthening each day (four sessions lengthening 0.25mm each time). This rate can vary between patients, depending on your health status.
As the two halves of the bone are separated, new bone begins to form in the gap. This is known as regenerate bone. At the same time, your nerves, blood vessels, skin and muscles also grow to accommodate the increased distance that they must now cover.
Complications can arise where muscles and other structures do adapt to the new length of the bone. Because of this, you will be very closely monitored throughout the distraction phase for signs of any complication, and particularly for signs that you are lengthening too quickly, since this can result in deformation of the new bone. Lengthening too slowly, alternatively, risks premature consolidation in individuals with a faster-than-average rate of bone healing.
The distraction phase ends once you reach your agreed lengthening target. Exceeding this target can risk very serious, and even life-changing, complications, and can also cause problems with the proportionality of your legs relative to your body.
The consolidation phase
The distraction phase is followed by the consolidation phase. This is when the new bone hardens and calcifies. Normally, you can begin to partially weight bear on the lengthened limb at this time, using crutches, or a walker, to support most of your bodyweight. The gradual increase in weightbearing helps the new bone to consolidate.
You can also improve your bone healing by modifying your diet to optimise your intake of certain vitamins and minerals, and modifying lifestyle factors which can have a negative effect on the healing process. Typically, consolidation will last at least twice as long as the lengthening phase.
Once the new bone has fully healed, your lengthening nail can be removed as an outpatient procedure. This is typically done about one year after your initial surgery. Some patients choose to exchange their nail for a solid nail earlier in the consolidation process, to enable them to return to weightbearing sooner.
Physiotherapy
As you lengthen, you will also undertake an intensive course of physiotherapy designed to support your healing, mobility and function. This will normally consist of daily sessions, up to five days per week.
In the days immediately following your procedure, exercises will normally be targeted toward pain management, the reduction of swelling, the preservation of your muscle strength and ensuring that your joints remain flexible.
During the distraction phase, exercises focus on movements that maintain flexibility and help to avoid contractures, or the tightening of muscles around the joints. If you have undergone femoral lengthening, these will target the hamstrings, quadriceps and hip flexors; if you have undergone tibial lengthening, these will target the gastrocnemius, soleus and Achilles tendon. Active strengthening exercises, including core work, resistance band work and leg raises, are also used to improve stability in the affected limb.
As you begin to weight bear, exercises that help improve your balance, like single-leg standing or standing on a balance board, become important, since they help you to adjust to the new dimensions of your legs.
During consolidation, resistance training, using bands and free weights, is employed to rebuild muscle and strengthen the new bone. Functional strength is built using closed-chain exercises like squats and step-ups. Joint mobilisation exercises can address stiffness and limitation in the knee, ankle and hip.
Once you are able to put your full bodyweight on your lengthened legs, you may continue to train to help improve your walking ability and stability. Once you are confident, you’ll be able to live a normal, active lifestyle.
What complications are associated with stature lengthening?
There are risks associated with stature lengthening which you should consider before taking the decision to move ahead with your surgery.
Infection is rare when lengthening the bone using an intramedullary nail. It is higher (up to 5%) in patients requiring external fixation, where pin sites provide an entry point for bacteria. Infection is commonly treated successfully using oral antibiotics, although deep infection may be addressed through surgical methods.
Soft Tissue Contracture is caused by the tightening of muscles, tendons and ligaments in line with the bone lengthening process which, in turn, restricts the movement of your knee and ankle joint. The degree of contracture is associated with the amount, and speed, of lengthening being undertaken, as well as your personal health factors. Contracture may be prevented by adhering strictly to your rehabilitation and physiotherapy regimen during the lengthening phase, which is designed to enable your soft tissue to stretch and remain elastic. In cases of very severe contracture, surgical intervention may be necessary.
Other categories of complication relate to your bodies ability to create new bone. Non-union occurs when the ends of the osteotomised bone fail to heal together, while malunion occurs when healing occurs with the bones in an incorrect position. Alternatively, bone may heal too quickly during the distraction phase, preventing lengthening. Premature consolidation, as well as uneven lengthening, can result in the development of a limb length discrepancy. In all cases, additional surgery is normally required for correction.
If the unconsolidated bone is subject to premature weightbearing, overload, excessive torsion or impact, it is at risk of refracture. Typically, this requires immobilisation during healing, in much the same way as a typical bone fracture, though can require surgical fixation.
Deep Vein Thrombosis (DVT) and Pulmonary Embolism, while extremely serious, are uncommon. Surgery itself is a risk factor for clot formation since it can be associated with trauma to blood vessels and localised inflammation around the surgical site which can reduce blood flow and increase the likelihood of clot formation. Substances are released by the body following surgery which can also increase the tendency of blood to form clots. More generally, the extended periods of immobilisation associated with the lengthening and consolidation phases of treatment slow blood flow to the lower limbs and further increase the risk of DVT. The risk of DVT is usually managed through the use of anticoagulant (anti-clotting) medicines, as well as compression stockings, early mobilisation and physical therapy.
Coming to Sydney
Beyond surgical excellence, choosing Sydney as the destination for your stature lengthening procedure comes with a range of benefits.
As an outpatient, you can enjoy internationally-recognised, five-star accommodation supported by an award-winning Guest Service team and offering easy access to some of Sydney’s best destinations and most iconic attractions.
Our rehabilitation partners offer world-class rehabilitation tailored to your individual needs. Your physiotherapy protocol embodies the very latest orthopaedic research to minimise the risk of complications, optimise your recovery and support you in safely reaching your stature lengthening goals.
Our Clinical Management Team are on hand to support you throughout. They’ll help you to schedule and manage your appointments, liaise with surgical and care staff on your behalf, handle processes and paperwork associated with your care and advocate for you tirelessly, so you can concentrate on your recovery, and returning to the things you love the most as quickly as possible.