procedure OVERVIEW
INITIAL CONSULTATION
The consultation starts with a specialized standing x-ray called an EOS scan. This is a low-radiation dose scan of your entire body from head to foot in a biplanar fashion (front and side at the same time). This scan may be performed the day before your consultation.
SURGERY
You will have a preoperative visit with the surgery team to go over the consent form and all of the paperwork. You will also have an appointment with our preoperative nurse and anesthesiologist.
HOSPITALIZATION
After surgery you will be taken to the recovery room for an hour or two before going to your room. If you have family or friends present, the surgery team will come out to talk to them after the operation. You will have an IV in your arm and nasal cannula/facemask for oxygenation.
LENGTHENING PHASE
No lengthening is performed in the first week after surgery. This is called the Latency period. One week after surgery, you will begin the lengthening (distraction) phase. During the lengthening phase, the PRECICE nail will lengthen the bone one millimeter per day (femurs) or three-quarter millimeters per day (tibias).
PHYSICAL THERAPY
Physical therapy (PT) is required daily (5 days per week) during the lengthening phase. The Paley Institute has a specialized physical therapy department on-site. All of the therapists have been specifically trained in the rehabilitation of lengthening patients and treat lengthening patients each and every day.
BONE HEALING PHASE
Once the desired length has been achieved, you will enter the bone healing (consolidation) phase and you can return home. There will be no changes to your activity level or restrictions until your bone has healed adequately. This usually takes 3 months.
HARDWARE REMOVAL
Once the new regenerate bone has completely healed and you have returned to your normal level of activity the final step will be removal of the PRECICE nails. Removal of the nails is a minor outpatient procedure. We advise patients to stay locally for approximately 3-4 days to make sure there are no further issues before going home.
The consultation starts with a specialized standing x-ray called an EOS scan. This is a low-radiation dose scan of your entire body from head to foot in a biplanar fashion (front and side at the same time). This scan may be performed the day before your consultation.
You will meet with our Stature Lengthening Coordinators, Angelique, and one of our Physician Assistants (PAs), Dayna, John, or Allan. They will obtain your medical history and explain the lengthening process in detail.
You will have a preoperative visit with the surgery team to go over the consent form and all of the paperwork. You will also have an appointment with our preoperative nurse and anesthesiologist. You can discuss your anesthesia and postoperative pain management in advance of the surgery. You will be given instructions for surgery. You should not eat or drink after midnight before the surgery, and you should come in two hours before your scheduled surgery time, to the preoperative area in the Kimmel building on the campus of St. Mary’s Hospital, 901 45th St.
After surgery you will be taken to the recovery room for an hour or two before going to your room. If you have family or friends present, the surgery team will come out to talk to them after the operation. You will have an IV in your arm and nasal cannula/facemask for oxygenation. While in the hospital you will start on mechanical foot compression pumps and an oral blood thinner to prevent blood clots. The nurses will make sure you are comfortable and positioned in such ways as to prevent pressure sores. You will have blood tests drawn each morning to check your blood level. In the rare event your blood level is low and you are having symptoms such a low blood pressure and an increased heart rate, a blood transfusion may be ordered.
No lengthening is performed in the first week after surgery. This is called the Latency period. One week after surgery, you will begin the lengthening (distraction) phase. During the lengthening phase, the PRECICE nail will lengthen the bone one millimeter per day (femurs) or three-quarter millimeters per day (tibias). In patients older than 50 years old we may choose to lengthen at a rate of 0.75 mm per day even for the femur. Lengthening is performed by the ERC device and you will be instructed in its use by an Orthopedic Technologist after discharge.
Physical therapy (PT) is required daily (5 days per week) during the lengthening phase. The Paley Institute has a specialized physical therapy department on-site. All of the therapists have been specifically trained in the rehabilitation of lengthening patients and treat lengthening patients each and every day. This experience is crucial to ensuring a positive outcome, maximizing strength and flexibility, and preventing complications.
The Paley Institute is unique among other centers in offering an on-site therapy department specifically catered to the lengthening patient.
Once the desired length has been achieved, you will enter the bone healing (consolidation) phase and you can return home. There will be no changes to your activity level or restrictions until your bone has healed adequately. This usually takes 3 months.
Continuation of physical therapy is important for strengthening, improving range of motion, and improving gait.
Once you return home you will need to send monthly x-rays to the institute for evaluation. The best way to do this is to upload your x-rays. We will send an upload link per your request.
Once the new regenerate bone has completely healed and you have returned to your normal level of activity the final step will be removal of the PRECICE nails. Removal of the nails is a minor outpatient procedure. We advise patients to stay locally for approximately 3-4 days to make sure there are no further issues before going home.
The stature lengthening method at the Paley Institute is divided into two phases: surgery and distraction phase and consolidation phase. Prior to surgery, patients are required to book an initial consultation. We need to assess you and ensure that you are as prepared as possible for this surgery.
