This is a case illustrating a 6.5 cm tibia lengthening done for lower extremity shortening related to the hip and proximal femur. The presence of a complex hip replacement prosthesis and hip joint instability led to choice of the tibia for lengthening. The Precice internal lengthening nail was used and the recovery was excellent. Gastroc-soleus recession was performed to prevent impending ankle equinus contracture.
The patient is a 37-year-old female with a complicated history of hip pathology from childhood. This included femoral head necrosis, fracture, and growth arrest. Ultimately, she was treated with a custom total hip replacement (THR) by a hip specialist who referred the patient for evaluation and treatment of LLD. The THR had problems of instability and was a constrained articulation. The overall LLD was 7 cm and she was comfortable wearing a shoe lift for short distances.
On exam she had excellent ankle mobility with 5 degrees dorsiflexion and 40 degrees of plantarflexion. Her subtalar motion was preserved, and her rotation was equal bilaterally.
Kirane Y, Fragomen AT, Rozbruch SR: Precision of the Precice Internal Lengthening Nail, Clin Orthop Rel Res. 2014. Epub Digital Object Identifier (DOI) 10.1007/s11999-014-3575-0.
Rozbruch SR, Zonshayn S, Muthusamy S, Borst EW, Nguyen JT: What Risk Factors Predict Usage of Gastrocsoleus Recession During Tibial Lengthening? Clin Orthop Relat Res. 2014 Feb 25. [Epub ahead of print]
Rozbruch SR, Birch JG, Dahl MT, Herzenberg JE: Motorized Intramedullary Nail for Treatment of Limb Length Discrepancy. J Am Acad Orthop Surgeons, 2014 July