Maimonides Bone & Joint Center offers comprehensive limb reconstruction and lengthening treatment for adults and children. Whether care is needed for congenital conditions, post-traumatic, neoplastic, or degenerative conditions, our team treats all conditions ranging from common to complex. Additionally, we treat children and adolescents with spinal disorders and deformities.
Amr Abdelgawad, MD, Director of Pediatric Orthopedic Surgery, and Brian Page, MD, attending physician in the Department of Orthopedic Surgery and recent arrival to Maimonides, share details on how Maimonides is making a difference in the lives of so many with these conditions.
Conditions We Treat
Patients of all ages with conditions leading to limb length discrepancy and limb deformity receive comprehensive care at Maimonides. These conditions can include:
- Congenital conditions: Individuals with congenital health issues resulting in one limb being shorter or longer than the other. Examples of these conditions we commonly treat in both children and adults includes fibular hemimelia, congenital femoral deficiency, and hemihypertrophy.
- Neoplastic conditions: Individuals who have undergone reconstructive surgery following sarcoma treatment may experience growth-related problems.
- Post-infectious issues: Certain infections can lead to growth problems or other limb length complications, like bone defects.
- Post-traumatic injury: Our treatment covers individuals who have lost limb length or are experiencing arthritis or stability issues due to a traumatic injury. These patients may currently use shoe lifts or have a severe limp. Trauma victims often present complex injuries, necessitating treatment that may involve correction of bone malrotation, misalignment, deformities, and limb length discrepancies as well as general reconstruction.
- Degenerative conditions: Arthritis can lead to deformity of the extremity. Correction of the deformity can decrease pain and avoid further progression of the arthritis.
While most orthopedists do not offer services for these issues, the Maimonides team provides comprehensive care. In addition to surgical procedures, Maimonides Bone & Joint Center offers on-site services including X-rays and physicial therapy.
According to Dr. Page, adult patients with limb length issues often get overlooked. The Maimonides team, however, is uniquely positioned with the expertise to make a difference for patients who may have been living with these conditions for years. We treat adults with limb length discrepancies, which often present with:
- Hip pain
- Knee pain
- Progression of arthritis
Individualized Treatments, From Innovative to Tried & True Surgical Techniques
Today, there are multiple treatment options available for limb reconstruction. “The most common surgical procedures our team offers are osteotomy or osteoplasty with lengthening,” said Dr. Page. “With lengthening, the surgeon will determine if the patient needs internal or external fixation, and what type of internal and external fixation is needed to correct the issue.”
In the past, most limb lengthening and reconstruction was done using external devices. “Over the last decade, new technology uses magnet-controlled internal devices so the patient doesn’t need an external device,” explains Dr. Page. “For each procedure, the surgeon determines which fixation is best for that patient’s situation.”
The team also performs bone transport to grow new bone after bone loss due to trauma, disease, or infection.
Healing and Recovery After Surgery
The duration of recovery varies significantly. “One major factor is the extent of the reconstruction we’re performing,” explains Dr. Page. “There’s a substantial difference between 2 and 8 centimeter lengthening procedures.” Additionally, limb lengthening recovery in children can occur at a much faster rate compared to adults.
Once a person has undergone surgery for limb reconstruction, there are three phases:
- Latency Phase: For the first week after surgery, the bone rests.
- Lengthening Phase: The patient comes into the office every two weeks during the lengthening phase. How long this phase lasts depends on how much length they’re trying to achieve, the person’s age and other factors. At each visit, the patient undergoes X-rays and the team checks how they’re healing. The team needs to ensure the patient isn’t developing complications, including in the nerves, muscles, tendons and blood vessels of the limb. During this phase, the patient also typically sees a physical therapist two to three times a week. “We have a physical therapist right in our department, so they work closely with the rest of the team to coordinate the patient’s care,” says Dr. Abdelgawad. “The patient must do a lot of stretching so the team can hit their goal length. The patient should also complete daily stretching exercises at home, as prescribed by their physical therapist.”
- Consolidation Phase: This is when the patient has reached the desired length and the care team is focused on overseeing the healing process. The patient comes into the office every four weeks during this phase.
Dr. Brian Page Joins Maimonides with Specialized Limb Reconstruction Skills
During his training, Dr. Page completed two fellowships, orthopaedic traumatology and limb lengthening and complex reconstruction, at the Hospital for Special Surgery. These fellowships provided comprehensive training in various aspects related to limb lengthening and limb reconstruction.
Our limb lengthening and limb reconstruction program takes pride in its strong training pedigree. In addition to Dr. Abdelgawad’s training at the International Center for Limb Lengthening in Baltimore, our surgical limb reconstruction team has received extensive training from two prominent centers in this field. With their diverse backgrounds, Drs. Page and Abdelgawad are equipped to provide the latest research-backed treatments to address limb-related issues in both children and adults.
Maimonides is the only pediatric trauma hospital in Brooklyn – and we’re proud to provide world-class limb reconstruction services close to home for patients and families of all ages. For more information, visit Maimonides Bone & Joint Center. To refer a patient, please call 718-283-7400.