Risks and Complications of Limb Lengthening

Limb lengthening is major orthopaedic surgery. Every patient who proceeds with us has read this page, discussed it with the surgeon, and signed a consent form that repeats it. We would rather you read it now, before you have invested hope, than later.

Common, usually minor

• Pin-site irritation and superficial infection. Common with any external frame. Managed with daily cleaning and, when needed, oral antibiotics. Occasionally a pin has to be moved.
• Muscle tightness and reduced range of motion at the knee and ankle during distraction. Expected; prevented and treated with daily stretching and physiotherapy. Skipping physiotherapy is the single biggest cause of lasting stiffness.
• Pain and disturbed sleep in the early weeks. Managed with medication and positioning; it improves as the weeks pass.
• Swelling of the legs and feet. Expected; elevation and movement help.
• Numbness or tingling around the incisions and pin sites, which usually resolves.

Less common, more serious

• Deep infection involving the bone or the implant. Uncommon; treated with antibiotics and, when necessary, surgery.
• Nerve irritation or injury, most often the peroneal nerve at the knee, causing weakness or numbness in the foot. Usually temporary when distraction is slowed; rarely permanent.
• Joint contracture or subluxation, particularly of the knee with large femoral lengthening or the ankle with tibial lengthening. Prevented by limiting the amount lengthened and by physiotherapy; sometimes requires a release procedure.
• Delayed bone formation or non-union, where the new bone does not form as expected. Managed by adjusting the rate, by weight bearing, and occasionally by a further procedure or bone grafting.
• Premature consolidation, where the bone hardens before the target is reached. Requires a repeat osteotomy.
• Axial deviation or malalignment, where the bone drifts from the planned line. Monitored on X-ray every two weeks and corrected during distraction.
• Fracture of the regenerate bone after the frame is removed, if load is applied too early. Prevented by following the consolidation programme.
• Implant problems: nail or pin breakage, loosening. Rare; may require surgery.

Rare, but you must know them

• Deep-vein thrombosis and pulmonary embolism. Prevented with blood-thinning medication, early movement and compression; treated urgently if they occur.
• Fat embolism, which can occur after any procedure involving the bone canal. Rare; monitored for in hospital.
• Compartment syndrome. Rare; a surgical emergency.
• Anaesthetic complications, as with any general anaesthesia.
• Chronic pain, or a result that does not match the plan.
• Very rarely, loss of function, loss of a limb, or death, as with any major surgery.

What raises the risk

Lengthening more than the surgeon recommends; smoking; obesity; poor bone quality; skipping physiotherapy; weight bearing against instructions; and poor pin-site care. Most of these are in your hands, which is why we are honest about the daily work.

When something goes wrong

Complications are managed by the same surgeon in the same hospital. Our written revision and support policy sets out which procedures within the first twelve months are covered by the surgical fee, what your travel insurance is expected to cover, and how decisions are made. You receive it before you pay anything. Read the summary on the patient protection page.

Our position

We will never call this surgery painless, risk-free or guaranteed. We will tell you what we see in our own patients, we will decline you if the risks for you are too high, and we will answer any question about this page in writing.

Ask the surgeon about your own risk profile