Leg lengthening in Turkey

Leg lengthening prices in Turkey

The average cost of a leg-lengthening operation in Turkey is 22,000 euros. Depending on requirements, the price can vary from 15,000 euros to 90,000 euros. It all depends on the desired length, as this has an impact on the duration of the treatment. The price includes pre-operative test, anesthesia, translator, hospital stay, medication, cab and 5-star hotel.

What is leg-lengthening surgery?

Leg lengthening is achieved using the body’s ability to regenerate new bone as well as the soft tissues, ligaments, blood vessels and nerves that surround and support it. The process begins with an operation called an osteotomy, in which the orthopedic surgeon cuts the bone to be lengthened. The limb (usually the upper or lower leg) is then stabilized using various external and/or internal fixation devices or frames.

Two recovery phases follow.

In the first, or distraction phase, the bone that has been cut is very gradually pulled apart, in a process that promotes distraction osteogenesis or the growth of new bone at the osteotomy area. Growth of new bone tissue is achieved by distracting or spreading the space, typically four times a day, by a quarter millimeter (¼ mm) at each adjustment, for a total of one millimeter (1 mm) per day.

As the space between the ends of the bone opens, the body continues to produce new tissue in the space until the desired bone length has been generated. Additional strategies are available to correct any deformity that may be present, such as bone misalignment resulting from trauma or congenital abnormality. At the beginning of this phase, patients walk with the aid of crutches in order to remain mobile.

The radiographic images above are of a femur osteotomy that was performed using a percutaneous approach. Progressive lengthening (8 cm) was performed with an internal lengthening nail to optimize leg length. Note the early formation of new bone in the cleft.

During the second phase of treatment, the bone consolidates and heals. The patient gradually puts more weight on the affected limb and begins to walk without any assistance.

The progressive lengthening process can be performed with an external fixator or an internal lengthening nail.

External fixation is a frame constructed on the outside of the limb and connected to the bone by pins (rods), screws and wires. External fixator adjustments can be used to progressively lengthen and straighten the short or misaligned leg.

The internal lengthening nail is a telescopic intramedullary nail or rod that is inserted into the medullary cavity of the bone. Thanks to a remote control device, the nail magnet is rotated, gradually lengthening the telescopic nail and the bone. With this method, the bone is straightened at the time of surgery, when the internal lengthening nail is inserted, and lengthening then occurs gradually over the following weeks.

The osteotomy and placement of most fixation devices can be performed under epidural anesthesia – the same type of anesthesia many women receive during childbirth – so that they can be awake during their operation if they wish. The average hospital stay is two days.. The procedure does not involve large incisions or bone grafts.

In general, patients who did not experience pain during surgery do not report any significant pain related to the operation or recovery.

Most patients have a leg length inequality that is the result of a congenital defect, a growth plate injury in childhood, or poor healing of a fracture in which the bones heal in a deformed position or a non-union in which the bones do not heal at all. However, limb lengthening can also be used to correct an arm deformity. And this procedure has been used to lengthen the arms and legs of people with exceptionally short stature, as in dwarfism or precocious puberty.

Another group of patients who can benefit from limb lengthening techniques are those whose limb is at risk of amputation due to lack of bone tissue, loss through infection, trauma or tumor. In what is known as a bifocal limb salvage procedure, an incision is made at the end of the bone opposite the affected site.

As this area is progressively widened, the ends of the bone that abut the gap are brought together. As with other limb-lengthening procedures, the area at the site of the osteotomy generates new bone; the area where bone was absent reunites and heals as any other fracture would. Even in such situations, we are often able to avoid an external fixator and use the bone transport nail.

Overall, limb-lengthening surgeries have a high success rate (around 95%). Scars are generally minimal, as only small incisions are required in most procedures. Although minor problems can occur with pins and joint stiffening, serious complications from limb-lengthening surgery are rare.

95% success rate

Overall, leg-lengthening operations have a high success rate (around 95%). Scars are generally minimal, as only small incisions are required in most procedures. Although minor problems can occur with pins and joint stiffening, serious complications of limb-lengthening surgery are rare. Those that do occur are usually seen in patients already considered high-risk, such as those being treated for limb salvage.

Recovery and rehabilitation

Recovery time after leg-lengthening surgery varies from patient to patient, with the consolidation phase sometimes lasting a considerable time – especially in adults. As a rule, children heal in half the time of adult patients. For example, when the desired goal is 1½ cm of new bone growth, a child will wear the fixation device for three months. In adults, although bone healing takes longer, the use of the internal lengthening nail makes the process simpler as there is no need to wear an external fixator.

Throughout the recovery period, physiotherapy plays a crucial role in maintaining the flexibility of the patient’s joints and muscle strength. Patients are advised to follow a nutritious diet and take calcium supplements. To speed up bone healing, progressive weight-bearing is encouraged, and patients take supplements such as vitamin D3 and calcium to speed up bone healing.

Eligibility for leg-lengthening surgery

Treatment of a leg length discrepancy should begin with a thorough evaluation by an orthopedic surgeon experienced in the procedure. Patients may be surprised to learn that what they thought was a leg length discrepancy, for example, is in fact an entirely different medical problem, such as scoliosis (an abnormal curve of the spine) or hip deformity. Or they may have a misperception of the unequal length of their limbs. At the Hospital for Special Surgery, orthopedic surgeons in the limb lengthening department obtain a special series of X-rays to accurately assess and confirm each diagnosis.

When there’s a real difference, even if it’s not the result of trauma, this asymmetry can lead to back, knee and ankle pain. In the event of poor consolidation (a fracture that hasn’t healed properly), osteoarthritis can develop. In some cases, a patient has lived with limb length asymmetry for many years without experiencing any problems and then develops troublesome symptoms in middle age.

“In addition to meeting the physical criteria for limb lengthening, it’s important that the patient is highly motivated,” explains Dr. Rozbruch. Patients play an active role in their care, actually lengthening their bones through remote adjustments, participating in physical therapy and meeting their doctor in person or virtually every two to three weeks throughout the healing process.

Leg lengthening surgery can be performed safely and effectively in children and adults, including those in their 20s, 30s, 40s, 50s and even 60s. In pediatric patients, the orthopedic surgeon takes special care to avoid injury to the growth plate, and osteogenesis through normal growth and distraction continues during recovery.

In some cases, such as children with congenital short femurs, it may be advisable to treat the problem in two stages. In this case, the child has a percentage deviation that increases as he or she grows; for example, a deviation of 5 cm at the patient’s first examination can be anticipated to reach a deviation of 7 cm in five or six years. In the case of the patient illustrated below, Dr. Rozbruch corrected a 5 cm deviation in a first procedure; another procedure will probably be necessary when the remaining deviation becomes larger.

The image above shows a gradual 5 cm lengthening of the femur, which was achieved using a device The images below were taken seven months later.

As this type of deformation can be up to 15 cm long, it is generally preferable to divide it into two or more operations.

Looking to the future

Leg-lengthening surgery is “in its infancy”, according to Dr. Rozbruch.

There has been a dramatic shift in the perception of this surgery … and interest in the field is growing rapidly, with many promising developments to come, including new devices that promote faster healing.

Recent advances include the approval by an official health organization of a fully implantable internal bone transport device, which can be used to reconstruct bone defects without the need for external fixation.

In addition, the phenomena that occur during leg-lengthening procedures, such as nerve regeneration and the development of a new vascular system, may have important future implications for a range of orthopedic and other medical conditions.

Clinic advice

It is not possible to lengthen by 15 cm in a single session. Max. 7 cm the first year and 7 cm more the following year. But the ideal is to plan for 5 cm lengthening. The patient will have fixators after the first operation, and will have to wait an average of 70 days for these fixators to be removed.

You do not need to stay in Turkey for 70 days. After the operation, you can return to your country and re-enter Turkey after 70 days.

If you would like a personalized quote on leg lengthening surgery in Turkey, please contact us.