Safe Cosmetic Leg Lengthening for Short Stature: Long-term Outcomes

Abstract

It is well known that limb lengthening is performed to treat limb-length discrepancies resulting from congenital anomalies and developmental problems. However, few studies discuss lengthening for cosmetic purposes. The current authors conducted a prospective study with long-term follow-up. From July 2002 through June 2007, 133 patients requested that their height be increased. Fifty-two were approved to undergo limb-lengthening surgery. Two were lost to final follow-up, leaving 50 in the study group. For all patients, the Ilizarov ring external fixator was applied with a maximum-stability technique that achieved frame stability and allowed patients to ambulate with a walker from the first week postoperatively. The method requires close follow-up for early detection of problems. Physiotherapy improved ankle function and prevented plantar flexion deformity, which can occur during lengthening. Excellent final outcomes were achieved in all patients except one, who required additional surgery. The Ilizarov device is a safe tool for limb lengthening in individuals of short stature when applied with the authors' maximum stability technique. To the authors' knowledge, this is the first article on this topic to report long-term results (minimum 5-year follow-up for all patients). Many factors influence the outcome of lengthening surgery performed with Ilizarov devices: the material of the rings, the use of a hybrid technique combining pins and wires, the diameter and number of pins over each bone segment, the size of the rings around the limb, the surgical technique for pin insertion, and the use of hydroxyapatite-coated pins or regular stainless pins.

Cosmetic stature lengthening

“…Cosmetic stature lengthening resulted in improved self-esteem and quality of life, and decreased distress and shyness levels. 5 - 7 , 11 , 12 , 16 - 19 Most patients reported high satisfaction rate and felt they would recommend the surgery for others with short stature. 5 , 6 , 17 Satisfaction, however, might not be predictable in patients with body dysmorphic disorder or dysmorphophobia.…”

Exploring the Ethics of Stature Lengthening as Treatment for Height Dysphoria

“… 4 , 9 Studies that utilised the Ilizarov external device found complication rates ranging from 37 to 70%, coupled with reoperation rates at 28 to 35%. 8 , 13 …”

“…Qualitative outcome measures based on height gain and the presence/absence of complications found that most patients obtain excellent results, although some have been noted to have only good or satisfactory results. 8 , 13 In the backdrop of risks and complications associated with stature lengthening, patients report high rates of satisfaction with the result along with improvements in self-esteem and self-confidence. 1 , 8 , 10 , 11 , 13 They would also undergo the procedure again and recommend it to others.…”

“…However, sole reliance on the patient to perform this calculus should be avoided as the high satisfaction rates despite high complication rates suggest patient bias in favor of surgery. 1 , 8 , 10 , 11 , 13 Rather, orthopedic providers should play a significant role in determining a clear risk-benefit ratio for each patient based on individual projected outcomes and anticipated complications. The orthopedic provider, in consultation with a psychologist, should be the gatekeeper to the procedure as patient values may be predetermined in favor of surgery.…”