Obtaining in adolescenthood 6 cm on femurs requires 5 years of natural growth, but only 2 months after a surgical procedure, i.e. 30 times faster! Imagine what would be the pressure on your joints and body while running 300 miles per hour (500 km/h)! The load on the body is extreme. For 6 cm of gain, natural recovery is so far 5 years. Without preparation, after a surgical lengthening, recovery can take 2 to 3 years, or even more. With a good preparation, it can take less than 1 year!
Without preparation, you could not go on the top of the Himalayas nor run the New York Marathon. The body is more shocked with a lengthening than with a marathon or climbing, and the need of a preparation is even more obvious. A good preparation shortens recovery time. You will have to accept to spend time for preparing your body.
Lengthening is a long procedure. One needs to accept withdrawal from professional activities for many weeks, and the risks of temporary problems or complications (e.g. infection over pins with external fixators, transitory stiffness's, etc.), and difficulties in this 'anti-nature ' procedure.
Acceptance of temporary problems is the foundation of success, as well as acceptance of a thorough preoperative preparation.
Personalized pre-operative training
The preoperative muscle evaluation guides the preoperative training and physiotherapy. An examination at the beginning of training and before the operation is desirable. Preoperative muscle and tendon preparation allows optimization of postoperative functional recovery. It will be performed in a gym under the professional control of a personal trainer, close to your home.
According to properties of your body (stiffness, flexibility, joint motion, muscle force, etc.) a custom preparation will be set for you.
Electronic muscle testing (Cybex®) provides precise values of forces and energy developed by muscle groups. Muscle deficiency before or after surgery is accurately determined, and rehabilitation is oriented towards compensation of deficiencies. In limb lengthening with the lengthening nail (Albizzia®), Cybex® testing shows that endurance muscles (not instant force muscles) are lost, mainly muscles, which operate against gravity (buttock muscles, quadriceps, and calf). Specific protocols for reinforcing these muscles are initiated, allowing for an early functional recovery, and allowing an increase in overall muscle strength.
A testing before preparation and after it (before surgery) will allow measuring the gain in muscle force you got. A new test before removal will see how much you recovered after the lengthening and if you need to train before removal of nails.
Type of report provided after an isokinetic test:
Psychological evaluation is essential. Limb reconstruction such as lengthening is a procedure that will change both self-image and body image as perceived by others (i.e., the social image). The patient will have to accept this new vision of their body. This change in self-perception will have less of a psychological impact if the desire for growth is focused on the physical lengthening process rather than on solving problems in domestic and social relations.
The purpose of the psychological evaluation is to delineate those people who wish to acquire a physical 'centimetric gain'. For patients whose demands are less clear; for instance, those seeking to repair familial and professional relationships, a gain of several centimeters will not resolve psychologically based problems. These patients will be assessed and oriented towards psychotherapeutic treatment that is better suited to resolving their difficulties.
Lengthening or a major axis correction is an intense experience. The process is painful, requires a commitment of time, and calls for a determined and motivated patient to complete the program. Transitory joint stiffness will be experienced for several months before a return to full normal activities and function can be expected. Fragile, weak and unstable persons will have more problems and won't succeed in the same way in lengthening than strong and stable people.
The patient's personality and ability to cope with these experiences will play an important part in successful lengthening. Some patients may stop their lengthening before reaching the initially aimed gain.
The actual surgery and healing process will entail a patient's withdrawal from everyday professional and scholastic activities; in addition, there is the possibility for transitory complications (e.g., pin infections). These challenges must be fully understood and accepted for a patient to complete the lengthening process.
The psychological evaluation will include a discussion, tests, and psychological support before or during the procedure, as needed.
Evaluation of Bone Quality.
A thorough biological blood check and a DEXA will allow to know bone quality and to adjust better the post-operative recommendations.
The Anaesthetist will ensure there is no problem, which could disturb the anaesthesia, or will anticipate on potential problems which may occur. He will discuss with you the type of anaesthesia, pain killers, etc.
Complementary preoperative tests
- Special long-leg x-rays (using ideally EOS technology)
- Cardiological consultation
- Dental consultation
- Blood test and medications to take one month preoperatively
- Motivation letter