The LimbplastX Limb Lengthening Surgical Procedure
Limb Lengthening Risks & Potential Complications
Low Risks & Comprehensive PreventionLimb lengthening surgery carries significant risks for complications. However, the overall rate of occurances is extremely low and the LimbplastX Institute employs every preventable measure to reduce even further the rate of complications and side effects. Through his extensive practical experience with limb lengthening and reconstruction, Dr. Debiparshad has developed comprehensive preventative measures, including highly specialized surgical techniques & protocols and pre & post operative physical therapy programs, to greatly mitigate the rate, risk and extent of complications.
Fat embolismThe risk of fat embolism occuring can arise anytime an implant is placed into the intra-medullary canal. The risk of this occuring is very low (less than 0.5%). However, a fat embolism can cause serious respiratory issues as the fat in the bone marrow is displaced to the blood stream and migrates to the lungs. The treatment for this is usually supportive until the fat dissolves. During the LimbplastX procedure we seek to prevent this from occuring by creating venting holes in the bone prior to placing the nail devices into the canal.
TransfusionMost centers performing limb lengthening on both legs report that approximately 25% of their cases require blood transfusions. During the LimbplastX procedure we administer specific medications and employ spcialized surgical techniques to mitigate bleeding, dramatically lowering the need for transfusions.
InfectionThe theoretical risk of infection to the surgical site is less than 1% and there have been no documented cases of infections occuring.
Non-UnionsOccasionally new bone may fail to adequately regenerate during the lengthening phase. The rate of occurance is extremely low at less than 1%. Treatment for this condition is fairly simple and easy to address with a unique feature of the PRECICE implant. This nail is the only impantable device available that is bi-directional, allowing for cyclic compression and distraction, sometimes referred to as "accordian loading". This remedial process allows for improved consolidation of new bone and can even accelerate growth rates.
Deep Vein ThrombosisDeep vein thrombosis (DVT) is a clot that can develop in the legs, which can in it self cause pain and swelling. In addition, these clots can migrate to other areas of the body, especially the lung to cause chest pain and shortness of breath. This can be a serious complication, but overall occurance is extremely rare (less than 1 %). To mitigate against this risk we keep patients on anti-coagulants during the post operative and rehabilitation periods and continue until otherwise instructed by the physician.
Implant FailureExamples of implant failure include lengthening mechanism failure, implant breakage and screw complications. Implant breakage is often related to non-compliance of patients with weight bearing restrictions.
With older designs of the PRECICE nail implant we saw a lengthening failure rate of approximately 5% and implant breakage rates of 7%. These failures required revision surgery to replace the implant.
In the newer edition of the nail we see far fewer "failure to lengthen" and implant breakage complications, with lowered rates of 1-2%. Screw complications (screw back out) have been reported as high as 3%. Though this is a realtively minor setback requiring a short procedure to re-tighten or replace the screw.
The best way to mitigate against implant complications is to be very compliant with the doctor's instructions. Any questions can be addressed through quick access to your doctor and trained physical therapists.
Delayed Bone HealingBone healing can be slow or fail to heal altogether, even though a rare complication with a very low 1.7% rate of occurance, it can lead to prolongation of non-weight bearing and activity restrictions. We try to mitigate against these complications by screening for risk factors such as medication use (non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, anticoagulants, steroids and accutane), tobacco and nicotine use, anemia, vitamin D deficiency, hypothyroidism, diabetes and poor nutrition.
We recommend a healthy diet with daily supplementation of:
Magnesium – 100 mg (25%)
Calcium – 500 -1000 mg (50-100%)
Silica- 30 mg
Boron- 2.5 mg
Strontium- 5 mg
Vitamin D – 1000 Iu (250%)
Vitamin C- 60 mg (100%)
Vitamin K (K1,K2)- 100 Mcg (125%)
Vitamin E- 30 IU (100%)
Vitamin B6- 5 mg (250%)
Zinc- 10 mg (67%)
Selenium- 75 mcg (107%)
Inositol – 500 mg.
In addition, surgical techniques used to minimize soft tissue stripping of the bone and allow for bone marrow stem cells to be released in the healing area will help prevent this complication.
Premature ConsolidationPremature consolidation occurs when lengthened bone heals too quickly, thereby stopping the ongoing lengthening process. If this does happen it requires an additional short surgical surgery procedure to re-separate the bone. This is a rare complication (0.5%) and is more common in the lower leg bone involving the fibula. Premature consolidation can be prevented by inspecting new bone growth during post-operative follow-ups that we conduct every 2 weeks. If we observe that this complication might begin to occur we implement preventative strategies involving specific medications.
Nerve PalsyWhen lengthening is occurring we can injure nerves by stretching them too quickly. This can result in numbness and even weakness, which can be permanent if not addressed in a timely fashion. This is a very rare occurrence, with a rate of less than 0.5%, but appropriate precautions should be taken prior to surgery.
The LimbplastX procedure includes pre-operative stretching and exercise guidance to help patients achieve optimal outcomes and avoid these types of complications. Furthermore, our 2-week physician follow-ups allows us to anticipate if the risk of nerve complications is increasing and alter treatment plans accordingly.
Muscle TightnessExcessive muscle tightness can develop that prevents full range of motion of a joint. Recovering and maintaining range of motion is a very important aspect of the procedure and patients must undergo continued physical therapy before and after surgery. The LimbplastX procedure includes pre-operative stretching and exercise guidance and comprehensive physical therapy after surgery to help patients achieve optimal outcomes and avoid these types of complications. Furthermore, our 2-week physician follow-ups allows us to anticipate if the risk of muscle tightness complications may be increasing and alter treatment plans accordingly.
During in-person consultations prior to surgery, patients are assessed to identify if there is a potential for excessive muscle and tendon tightness. Surgical releases may be required and are carried out during the limb lengthening surgery.