It would appear that leg-lengthening operations are seldom justified. While there is understandable hesitancy in operating on a healthy, normal longer leg in order to arrest epiphyseal growth or to cause immediate shortening by osteotomy, such procedures under present conditions of control are fraught with less danger and are less formidable than are leg-lengthening procedures. No method of epiphyseal stimulation is as yet well enough established to warrant serious consideration but one cannot avoid the idea that even if epiphyseal stimulation should be successfully evolved and increased longitudinal growth produced, the muscle power would probably suffer relative loss similar to that occurring ill leg-lengthening procedures. The same disadvantage of increasing lever length in the presence of already weakened muscles would apply.
If a patient is old beyond the chance of epiphysiodesis causing satisfactory reduction in leg-length inequality and if the over-all stature of a patient is so short that any reduction of height by leg-shortening is undesirable, leg-lengthening might be considered. On occasion parents absolutely refuse to permit any surgery on the good leg. In such a case leglengthening might be considered. If considered, the following criteria should be met.
1. Adequate muscle power should be present about the hip and thigh to control the lengthened unit.
2. Shortening of at least one and one-half inches must be present to justify such a formidable procedure.
3. A maximum gain of not more than three inches should be attempted.
4. Good bone and joint structures should be present, lengthening being contraindicated in cases of old osteomyelitis and old joint disease.
In the final analysis, prevention rather than correction of leg-length inequality is the most desirable goal, and it is along these lines that the greatest efforts should be expended. The truth of this statement is brought sharply to attention if for a moment one imagines that if the present-day armamentarium of vaccines and antibiotics had been available three decades ago, all thirty-nine cases of poliomyelitis and the eight cases of pyogenic hip disease might have been eliminated leaving only the cases of congenital deformities or epiphyseal injuries to contend with. Regardless of how the future may assist in improving these conditions, we cannot escape the fundamental concept that improved function, not just increased length, is the objective, and that these terms are not synonymous. This fact is clearly underlined by the end results in these patients studied some twenty to twenty- eight years after their original surgical procedures had been performed.
Copyright 1958 by The Journal of Bone and Joint Surgery, Incorporated