Day 2 Final Speaker: 3rd Annual Achondroplasia Research Conference recap
We were very excited to hear from the day’s next speaker, Chandler’s personal limb lengthening surgeon!
Shawn C. Standard, MD, FAAOS is the Head of Pediatric Orthopedics at the International Center for Limb Lengthening RIAO, at Sinai Hospital. Dr. Standard showed us photos of Chandler before and after her limb lengthening surgery, as well as other patients who have opted to do the same. He left us with numerous thoughts and takeaways, which we have summarised below:
Dr. Standard wanted us to understand the three goals of limb lengthening surgery:
- To achieve functional height (a technical term used in the field)
- To achieve equal leg lengths and optimum limb alignment
- To turn the pelvis upward and straighten the lower back so that they’re straight and the patient can stand up
His job is to maintain joint mobility and neurologic function, while improving a patient’s functionality. He also made it very clear that a limb lengthening surgeon should never sacrifice a joint for length during a surgery.
- Hip abnormalities and spinal stenosis are another key issue in achondroplasia, but for healthcare professionals to spot them, a careful patient history and physical examination is essential. If found, these need to be addressed separately to limb lengthening.
- Corresponding gait improvements occur with dedicated physical therapy. Physical therapy can help patients strengthen the muscles that they never used before undergoing limb lengthening surgery.
- When it comes to the surgery itself, Dr. Standard noted that all limb lengthening surgeries should be staged over time. The typical limb lengthening surgery consists of two separate leg surgeries and one arm surgery.
- The total limb lengthening surgery process accounts for 10-12 months. When broken down, the timeline looks as such post limb lengthening surgery:
- 10-16 weeks = Distraction phase
- 4-12 weeks = Healing phase
- 12 weeks = Functional recovery phase
- Patients will not be bedridden after limb lengthening surgery, but they will need physical therapy.
- Between 4 and 6 inches can be gained when lengthening both a patient’s femur and tibia. This means that the total length achieved after lengthening a patient’s legs over the course of two surgeries is between 8 to 10 inches. Dr. Standard reassured the audience that limb lengthening and realignment can be done at the same time.
Dr. Standard took us back to basics and explained how to lengthen a bone. The process is as followed:
Break bone –> let bone rest for a week –> bone then consolidates –> you remodel the bone –> then let it heal
- Dr. Standard recommends starting the process of limb lengthening as young as 8 years old. He reassured listeners that there is no cut off age for the surgery. He does caution that the potential for bones to heal decreases the older you get, which means your flexibility can suffer if you wait too long to have limb lengthening surgery. He stated that bone density does return to normal.
- To increase functional reach, Dr. Standard says to do humerus lengthening as early as 10 years old. However, lengthening the forearms is not recommended as that results in a decrease in rotation and motion.
- Dr. Standard hopes to see a world were limb lengthening and new drug therapies can be used together to treat patients. Patients can currently undergo limb lengthening surgery while on drug treatments.
