Phases of the lengthening procedure

Leg lengthening should be seen as a shared journey between the surgeon and the patient, having a good post-operative period begins with choosing the right patient for this procedure. At a minimum, the following criteria should be considered before agreeing to start surgery.

1. Strong family support

The recovery process takes months, the patient will need help with daily tasks such as the use and manipulation of the remote control and the daily stretching session, if the patient does not have solid support from his family, this procedure may not be the right one for him.

2. Reliable patient

The lengthening process requires that the patient follow all post-operative recommendations, they are expected to follow the specific instructions given by the surgeon and perform daily exercises for an extended period of time. Additionally, the patient will need to attend regular appointments to ensure a successful outcome.

3. Compatibility between bone and implant

Before considering Precice surgery as an option, it should be verified that the diameter and length of the bone are optimal for Precice.

4. About soft tissue

It must be ensured that the distance between the skin and the center of the bone allows adequate communication between the magnets.

5. Anxiety/Depression

An evaluation of the patient's psychological health is important, given that those who present anxiety and/or depression may have a higher risk of a more difficult postoperative period.

6. Narcotic dependency

Like the previous case, patients with narcotic dependence should be evaluated by a pain clinic before surgery to implement pain management strategies.

1.  Physical therapy evaluation

Physical therapy is such an important component to the success of treatment that the process should begin prior to surgery, so that the therapist can familiarize the patient with the strengthening program and range of motion that will be required after surgery, gait training and other aspects more effectively before surgery.

2.  Psychology

Having a therapist available to see the patient on a regular basis will help address the anxiety, stress, frustration, and depression that can arise during the months of treatment and post-op.

Precice implantation procedure

To carry out this surgery, a corticotomy (cut in the bone) is performed, which allows optimal bone regeneration during the lengthening process. At the end of the surgery, the specialist activates the device to verify the correct functioning of the Precice.

Step 1

Surgical access is performed through minimally invasive technique: The specialist makes a small incision (cut) and creates an opening at the end of the bone to be treated.

Step 2

The appropriate implant is inserted: The device with the adequate diameter and length is inserted into the medullary canal (center of the bone).

Step 3

The implant is fixed to the bone: Two small incisions are made at the opposite ends of the bones, to introduce the secondary implants and thus secure the device normally in four points.

1.  Post-operative follow-up appointments (every 2 weeks)

There are multiple details to monitor during the lengthening phase. Appointments during the postoperative period allow us to evaluate the formation of bone regeneration, the range of joint movement and respond in a timely manner to any anomaly that may be presenting.

2.  Weekly physical exam

The following items should be evaluated for the weekly physical exam during the lengthening phase:

• Pain level

Limb lengthening should involve minimal discomfort. If the patient continues to have considerable pain after surgery, the reason causing it must be evaluated. If the patient does not have pain and begins to feel it, this is a clue that something is not right, what may be causing it must be studied. pain and treat it.

• Assessment of range of motion

Each visit requires careful examination of joint range of motion above and below the lengthening segment. The doctor must have a weekly record of the arcs of joint movement to be able to make a comparison.

If the patient is losing range of motion, compliance with the home exercise program should be verified. The number of physical therapy sessions can be increased, and lengthening decreased or stopped until range of motion is recovered.

• Evaluation of wounds

Surgical incision sites should heal in 7 to 10 days, although the incidence of infection is low, incision sites should be checked every week. Patients with previous external fixators have a small risk of developing a deep infection at the pin site.

3.  Periodic X-rays (every 2 weeks)

There are multiple details that should be examined on control x-rays. It is important therefore to have a checklist to ensure that none of the following elements are overlooked:

• Implant status
• Expected elongation
• Bone regeneration
• bone alignment

Healing Phase

Once the lengthening phase is considered complete the patient will enter the healing phase. Appointments will go from every two weeks to monthly. The main concerns during the healing phase are safe progress in managing weight on the leg and range of motion of the leg.

Removal

Once the patient can bear full weight without pain, appointments can be extended to approximately every three months. During this phase, the healing of the regenerated bone is mainly evaluated to determine when the patient is ready to remove Precice.

Generally, all implants should be removed from pediatric patients, while removal of devices from adult patients should be decided on a case-by-case basis.