Limb Lengthening: A Restorative Procedure

Ankle osteoarthritis is a condition that causes pain and stiffness in the ankle joint. Traditional treatments like joint fusion can limit mobility. An alternative procedure called ankle distraction arthroplasty has been gaining some traction, but how well does it hold up in the long term? 

A recent study by Greenfield et al. (2019) investigated this very question. They conducted a survival analysis of ankle distraction arthroplasty for ankle osteoarthritis. Their findings suggest that this procedure may be a viable option for some patients. 

Key takeaways from the study: 

  • Ankle distraction arthroplasty showed promising results, with an 84% survival rate at 5 years. This is better than some previously reported outcomes. 
  • The study also identified factors that can influence the success of the procedure. Avascular necrosis of the talus (bone death) was associated with a lower survival rate. Additionally, sex may play a role, with the study suggesting potential gender differences in long-term outcomes. 

What this means for patients: 

Ankle distraction arthroplasty offers a potential option for preserving joint mobility in patients with ankle osteoarthritis. This study provides valuable data for surgeons and patients to consider when making treatment decisions. 

Important to note: 

  • This was a retrospective study, meaning researchers analyzed past data. More robust research designs are needed to confirm these findings. 
  • The study involved a relatively small group of patients. Larger studies are necessary to draw more definitive conclusions. 

Overall, this research suggests that ankle distraction arthroplasty may be a valuable tool for treating ankle osteoarthritis. However, more research is needed to solidify its place as a standard treatment option. 

ReferenceGreenfield, S., Matta, K. M., McCoy, T. H., Rozbruch, S. R., & Fragomen, A. (2019). Ankle distraction arthroplasty for ankle osteoarthritis: a survival analysis. Strategies in trauma and limb reconstruction, 14(2), 65.,and%2037%25%20within%205%20years


This blog is for informational purposes only and should not be considered as medical advice. Always consult with a qualified healthcare professional to discuss your individual treatment options.

Limb Lengthening: A Restorative Procedure
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There are a variety of reasons that the limbs of our bodies can vary in length. These include fractures, the onset of an illness, or a congenital defect. The body is designed to be symmetrical, and the difference in limb length affects both the mobility of a person and in some instances it can affect their confidence. Innovative surgical procedures have been developed that can correct the difference in limb length and improve overall functionality of the individual. 

Limb lengthening is based on the principle that the body can heal itself if the right conditions are induced. By utilizing the body’s ability to regenerate new bone and auxiliary systems, it is possible to train the bone to reach the desired length with the appropriate medical mechanisms. 

What is the limb lengthening procedure? 

Limb lengthening begins with the cutting of the bone, in an operation known as osteotomy. A scaffold is then built around the cut area either internally with a limb lengthening nail or externally with a fixateur. Once the surgery is complete, there is a two phase recovery period. The first phase is known as the distraction phase, involving the process of gradually pulling apart the bone, in the region where it was initially cut. At the interface of the cut, there will be a continuous growth of new bone tissue. The gap is adjusted typically four times per day at a rate of 1 mm a day in quarter increments. The gap between the bones is adjusted daily, until the desired length of bone is generated. If there is any additional alignment of the bone to be corrected, it will be adjusted during this phase as well. Patients do remain mobile while they undergo treatment via utilization of crutches. 

X-ray of an osteotomy of the femur and limb lengthening using percutaneous approach, with a three-month progression to 8 cm (3.25 inches).
Image reference: HSS

During the second phase of the limb lengthening process, the bone consolidates or hardens and eventually heals itself. Eventually the patient will be able to apply weight to the limb, and after the required healing time they can resume normal activities. 

Pain Management during Bone Lengthening

The osteotomy and fixation device insertion is conducted utilizing epidural anaesthesia. Patients are often awake during their surgical procedure. As a minimally invasive surgery, no large incisions are made in the patient’s leg and they are usually able to return to their homes after two days of hospitalization. The healing process from this surgery is one that is relatively pain free. The majority of patients have no complaints of significant pain. 

The success rates of limb lengthening surgeries are very high at approximately 95%. With minimal scarring, the procedure is one that results in the limbs restoring nicely once they are fully healed. One minor side effect that may be experienced is stiffening in the joints. 

Healing Time After Surgery 

The limb lengthening surgery is one that is conducted on both adults and children. Children generally heal faster than adults, and in this instance their healing rate can be as much as half the healing time of adults. Adults may take up to six months to acquire 1.5 inches of growth. Via diet and exercise, patients can enhance their healing process. 

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Dr. Gordon Slater

Dr. Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions.

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Dr Gordon Slater is a highly-skilled surgeon specialising in foot and ankle conditions and sports injuries. Dr Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions. MIS  has many advantages including shorter operating times, reduced post-operative pain, reduced risk of infection, minimal scarring and better cosmetic outcomes.

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