Children’s Orthopaedic & Spine Care Center

Limb Lengthening and Height Gain procedures

Limb Lengthening Treatment for children / Height Gain procedures

Limb lengthening treatment for children and adults is a process by which our limbs – upper limbs and lower limbs, are made longer. Limb lengthening treatment for children and adults may be needed because it is shorter than the opposite side.

A limb can be shorter for many reasons such as congenital condition like Hemimelia, or congenital shortening of the Femur (thigh bone). Conditions that result in cessation of growth (a growth arrest) – like infection and injury, can also result in a short limb. A deformity often accompanies the shortening in these cases.

Limb Lengthening treatment for children and adults is carried out on the shorter limb or limb segment in order to make the 2 limbs equal. Any deformity that is present is simultaneously corrected. Some of the children have large lengthening goals (15 cms or more), and therefore need 3 to 4 surgeries over time.

Quite frequently, limb enlargement surgery (lengthening) is carried out for both lower limbs. Lengthening both lower limbs results in an increase in height (Height increase surgery). In our clinic, this is commonly done for people who have genetic problems which render them small, and desirous of gaining height (Increased height surgery). Occasionally, people of normal or slightly less than normal height wish undergo height increase surgery. The process of leg lengthening surgery to both lower limbs is applied to them as well.

Height Enhancement surgery: A 14-year-old female child with severe shortening. Both the Tibiae (Leg bones) are being lengthened.
5 cm lengthening and height gain has been achieved with fully strong new bone formation. This girl will undergo 3 further height enhancement surgeries in order to achieve a ‘functional height’.

How does an operation actually make a limb longer and increase height? How do we do height adding surgery?

The method to biologically lengthen bone was invented by Prof. Gavriil Ilizarov, a Russian doctor. He created new bone by gradually increasing the gap between surgically divided ends of bone. He developed a system of predictable safe lengthening termed as Distraction Osteogenesis. As the gap increased between bone ends and filled with bone, the soft tissues also increased the length in response to the distraction stress. Nerves, blood vessels, muscles, all increased their length proportionally. This phenomenon was labelled as distraction histogenesis.
The distraction osteogenesis forms the basis for all lengthening of limbs that are carried out today. We have learnt from Prof. Ilizarov’s methods that lengthening a lower limb bone segment by 4 cms can be safe at one time. At times, 2 segments (such as Femur and tibia) can be simultaneously or sequentially lengthened to achieve a lengthening of 8 cms. Lengthening of the same bone can be repeated after a gap of 3 years.

Immediately after surgery
Shows gradual elongation of bone with creation of gap in the divided bone
Shows gradual elongation of bone with creation of gap in the divided bone
Shows bone filling in the gap.
Shows bone filling in the gap.
Shows the bone as completely healed. The femur bone is longer by 4.5 cms. Fixator was removed at this stage.
Shows the external lengthening device (Fixator).

How Do I proceed with Limb Lengthening Surgery in India or a Height Adding surgery?

Book an Appointment

Timing :

  • 10:00AM – 4:00PM
  • Book a video consultation
  • Write to us at  and send all the relevant investigations and clinical details.

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Have a physical check by Dr Sarup and his associates on the appointment day.

Expect a scanogram x-ray to be done. A plan of treatment will be formalized after full evaluation and will be discussed with you.

Blood tests, Pre-anaesthesia check will be carried out. A date for surgery with pre-operative instructions will be given. An estimate of cost will be given.

You must discuss any questions you have with Dr Sarup or his team. It is helpful to write these down before the consultation.

You will need to discuss all the special needs that you may have. Physiotherapy and dressings are possible at home, and our dedicated team members will make home visits. You may need to make arrangements to study / work from home for a few months. You will need ambulation assistive devices like walker, crutches etc. You will also meet our physiotherapists who will train you on exercise, and walking aids. The home environment may need to be checked out by our therapist to suggest aids and assistive devices.

You/your patient will be admitted on the day of surgery, usually 2-3 hours before the procedure.

Final checks will be carried out, consent forms will be signed and you / your patient will proceed for surgery.

Dr Sarup and his associates will see you after the operation and apprise you on the procedure.

We usually bring the patient back to the out-patient clinic once a week till lengthening is completed.

It takes at least a month after fixator removal to be reasonably mobile and be able to return to work or school.

Large Height increase surgery can be tedious. Patients and their families have to work hard with us and our health care specialists. We, as a team at COSCC, help all our patients to achieve the best possible results.

Types of Limb lengthening systems and devices

External fixator – Mono-lateral external fixator

In this lengthening device, the pins are applied to one side of the limb, and the fixator sits on one side – usually outer aspect of the thigh or the front side of the leg

Limb lengthening treatment in children: This 5 year old is undergoing limb enlargement surgery / lengthening with a mono-lateral external fixator.

Circular external fixator system – Ilizarov type

Here, the system has metal rings that encircle the limb. The pins attach to the rings. This design is close to the classical system for limb lengthening

This 7 year old girl is having her femur (thigh bone) lengthened over a classical ring fixator – Ilizarov type.

Circular external fixator – Hexapod external fixator

This device uses 2 rings connected by a hexapod frame. The lengthening is planned out, and a computer software programme devises a lengthening plan. This system is more useful where the limb shortening is accompanied by a deformity.

Limb lengthening surgery in India: This 14 year old has a complex deformity with severe shortening. Both deformity correction and lengthening is being carried out over a hexapod frame. This system is exact and the lengthening program is guided by computer software

Internal Lengthening device – Magnetic lengthening Nail system.

This is a new system now available in India. A magnetic lengthening Nail device is inserted into the bone to be lengthened. The entire device is internal and not visible. Lengthening is achieved 3-4 times a day by placing a magnet driver over the leg to achieve a distraction of 1 mm per day.

Limb lengthening surgery in India : The metal self-elongating device is inserted surgically within the bone. There is no external device. A remote hand-held controller activates the lengthening of the nail. The discomfort and inconvenience is minimal by this method

FAQ (Frequently Asked Questions) section below.

Do I need Limb lengthening surgery?

It depends on the clinical situation. Broadly speaking, Limb or leg lengthening surgery is done in 2 situations

  • When one limb is shorter than the other.This is by far the most common situation in our centre.
    A limb may be shorter
    • by birth (congenital)
    • Damage of growing areas of bone (called the Physis) because of injury or infection.
    • Damage to growing area due loss of blood supply, or irradiation as in tumour treatment.
    • Overgrowth of the opposite limb due to various causes

When lower limbs are of different lengths, it causes an asymmetry. If the difference is small (1 centimetre-1.5 centimetre), it may be hardly noticeable.
If the difference is over 2 centimetres (cm), a limp becomes noticeable.
With larger difference in limb lengths (limb length discrepancy – LLD), the problem increases. In addition to being cosmetically disadvantageous, walking and running become abnormal and difficult. The limp is proportional to amount of limb length discrepancy.
Over a period of time, the joints of the lower limb get affected and the joints of the lower spine (called facet joints) develop arthritis. Some children develop a scoliosis (a side bend of the spine) as well.

Once there is significant Limb Length Difference, Limb equalization is needed for the medical reasons described above

  • When a person is shorter than normal and wishes to increase stature (A height gain surgery in India).
    This is referred to as cosmetic limb lengthening , or height enhancement surgery, or stature gain surgery. Usually, the limbs are equal in this situation. Surgery is carried out on both the lower limbs to make them longer.
    There can be 2 clinical circumstances where this is carried out:
    • In the first condition, a person may be shorter than what is the normal for his/ her ethnicity. This can be simply determined by a growth chart and a height measurement.
    • In the second, the person may have a stature considered within normal parameters by the growth chart and still wishes to increase the height.

In cosmetic limb lengthening or height increase surgery, the decision to have surgery must be carefully made by the patient and the family.

How is Height enhancement surgery or leg lengthening surgery done?

Once The patient has decided to have surgery, our team will make a detailed assessment.
Blood tests, Radiographs, A Scannogram and measurements are carried out. Pre- anaesthesia checks are carried out.
Dr Sarup will examine you in detail and make a plan for surgery and its aftercare.

Patient is usually admitted on the day of surgery. A general anaesthetic is administered and an epidural cannula is placed in to prevent post surgery pain.
Under anaesthesia, the bone to be lengthened is divided. A lengthening device is placed to fix the bone (see types of lengthening). The patient is then woken up and brought back to the room. Physiotherapy is started the next day. The patient is discharged home on the 4th day after surgery.

Lengthening device is activated 7-12 days after the operation. Distraction is carried out between 0.75 to 1mm per day – usually done fractionally every 6-8 hours. Once target length is reached, lengthening is stopped.
Physiotherapy is continued on a daily basis to achieve good movement and strength for the leg muscles.

Dressing is carried out on alternate days. The distraction creates a gap in the bone which gradually fills up with new bone. The soft tissues also undergo elongation with the distraction. The new lengthened bone slowly becomes as strong as normal bone, and the lengthened limb becomes as strong as the normal limb.

Is limb enlargement surgery / leg lengthening surgery painful?

The surgery is carried out under anaesthesia and therefore it is painless.
All major surgeries have a variable degree of pain in the first 48 hours. We manage pain and discomfort with the help of epidural analgesia and intravenous analgesics.

Our dedicated pain team monitors patients in the post-operative period to ensure that pain is kept away.
External fixators tend to have a level of discomfort, especially with older children, but this is variable. This discomfort can be kept under excellent control with oral medication. Physiotherapy and exercises, done diligently, also go a long way in an early return to normalcy.

Is limb enlargement surgery safe?

Limb lengthening has similar risks as any other routine operation where implants are used. Additionally, there are risks unique to this procedure – the bone healing may be delayed or may not be complete. There are solutions available if this happens.
However, it is highly advisable to have these procedures done by Orthopaedic surgeons who are well trained, and who have plenty of experience in this field.
Do choose your surgeon carefully.

In our clinic, the most common complication is a pin tract infection. This is treated with dressings and culture specific antibiotics.

How long does it take to recover from limb lengthening surgery?

The limb lengthening surgery itself is a short process requiring 5 days in the hospital.

Lengthening is started after 1 week. Lengthening is carried out at the rate of 1 mm per day. As a general rule, 4 centimetres of lengthening takes 60 days, and the external fixator has to maintained for a total period of 4 months.

If an internal lengthening device is used, the healing time is similar but the internal device is not removed.