Limb Lengthening Surgery: Internal Lengthening Device

Recovery after limb lengthening surgery with an internal lengthening device goes best when you know what to expect. The surgery is a big commitment, and it takes most kids a few months to get back to full activity. With your help, your child can get the best results.

Why Is Limb Lengthening Surgery With an Internal Lengthening Device Done?

The surgery is done when someone has a leg length discrepancy. This means that one leg is shorter than the other.

What Is an Internal Lengthening Device?

An internal lengthening device is an expandable rod that's placed inside a bone. There is a magnetic gear system inside the rod. A handheld remote controller goes on top of the skin and uses another magnet to slowly lengthen the internal device. Many surgeons use an internal lengthening device called the PRECICE®.

What Happens During Limb Lengthening Surgery?

The surgery to place the device is done by an orthopedic surgeon. It's done in several steps:

1. Your child will get general anesthesia to sleep through the surgery without feeling any pain.
2. An incision (cut) is made through the skin and the lengthening device is inserted into the bone.
3. Another incision is made so the bone can be cut. This is where the new bone growth will happen.
4. The lengthening device is pushed through the cut bone.
5. Screws are put it in to keep the lengthening device in place.
6. Using the remote controller, the surgeon makes sure that the magnet motor is working properly.
7. The incisions are closed with stitches.

How Should We Prepare for Limb Lengthening Surgery?

Making some plans before the surgery will help you be prepared when your child comes home from the hospital. Some things to consider:

• Plan for your child to be in the hospital for about 1–2 days after surgery. While your child is in the hospital, you'll learn about caring for him or her at home. You will also learn how to use the remote control for the limb lengthening device.
• For the first few weeks, your child will need help getting dressed, going to the bathroom, and bathing.
• Your child will need help doing stretching and strengthening exercises. These are a very important part of healing. You, or another trusted adult, will need to be there to help your child.
• Make arrangements for your child to be home from school for about 6 weeks. Talk to your child's school so that work can continue while your child is at home. The school may be able to provide a home tutor.
• Plan who will take your child to the follow-up appointments with the surgery team and to physical therapy.
• Not being able to put weight on one leg for months can be stressful for your child and for you. Using crutches or a walker gets tiring. If you can, arrange for another trusted adult to stay with your child so you can get a little time for yourself. And arrange for your child to visit with friends or go for safe outings with a trusted adult, maybe using a wheelchair.

What Happens After Limb Lengthening Surgery?

Your child needs your help after surgery. He or she should not put any weight on the newly lengthened limb for several months. Following the orthopedic care team's instructions will help your child get the best result.

For about 6–8 weeks after surgery, you will need to:

• Help your child use crutches, walker, or wheelchair to get around as instructed by your care team. Your child should not put any weight on the leg with the internal lengthening device during this time.
• Use the remote controller as directed by the surgeon, usually about three times a day. It's programmed specifically for your child.
• Take your child to physical therapy and possibly aquatic therapy (physical therapy in a pool).
• Help your child with stretching and strengthening exercises.
• Give your child medicine for pain and muscle spasms. Your child will have pain from the surgery and may have pain during the exercises and stretches. The pain medicine will include opioid medicines. Opioids are very good at treating pain, but they can be dangerous if not given as directed. They also can lead to addiction. It's important to safely give opioid pain medicine.
• Help your child get the nutrition needed to grow new bone and recover from surgery. He or she should eat a balanced diet that includes 3–4 servings of dairy and plenty of fruits and vegetables every day. Your care team also may recommend vitamin supplements.
• Go for follow-up appointments with the surgery team about every week. X-rays will be done at each visit to check your child's progress.

The time it takes to reach the desired limb length varies, it's usually within a few months after surgery. Once lengthening is complete, you will stop using the remote controller. The lengthening device stays in place to support the growing bone.

Be sure to:

• Follow the orthopedic care team's instructions about when it is OK for your child to put weight on the newly lengthened limb.
• Continue to take your child to physical therapy and do home stretching and strengthening exercises.
• Continue to take your child to follow-up visits with the surgery team about every 4 weeks. X-rays will be done at every visit to see how the bone is healing.

Gradually, as the new bone gets stronger, your child will be able to do more and more. Most kids get back to their usual activities about 6–9 months after the rod was placed.

The implant is removed 1–2 years after surgery. Your child can go home from the hospital the same day that it's taken out.

Looking Ahead

To get the best result, your child will need your help in the months after surgery. Keep a positive attitude that lets your child know that you can do it together. After the process is complete, most families say that the surgery was well worth the effort.

If you or your child are feeling very stressed or overwhelmed, be sure to talk to a psychologist or the social worker on your care team.