title: Is bilateral lower limb lengthening appropriate for achondroplasia?: midterm analysis of the complications and quality of life.
abstract: BACKGROUND
  Use of the Ilizarov technique for limb lengthening in patients with achondroplasia is controversial, with a high risk of complications balancing cosmetic gains. Although several articles have described the complications of this procedure and satisfaction of patients after surgery, it remains unclear whether lengthening improves the quality of life (QOL) of these patients.
  
  
  OBJECTIVE
  We asked whether bilateral lower limb lengthenings with deformity correction in patients with achondroplasia would improve QOL and investigated the correlation between complication rate and QOL.
  
  
  METHODS
  We retrospectively reviewed 22 patients (average age, 12.7 years) diagnosed with achondroplasia who underwent bilateral lower limb lengthenings between 2002 and 2005. These patients were compared with 22 patients with achondroplasia for whom limb lengthening was not performed. The two groups were assessed using the American Academy of Orthopaedic Surgeons (AAOS) lower limb, SF-36, and Rosenberg self-esteem scores. Minimum followup was 4.5 years (range, 4.5-6.9 years).
  
  
  RESULTS
  Among the lengthening group, the average gain in length was 10.21 ± 2.39 cm for the femur and 9.13 ± 2.12 cm for the tibia. A total of 123 complications occurred in these 88 segments. The surgical group had higher Rosenberg self-esteem scores than the nonsurgical group although there were no differences in the AAOS and the SF-36 scores. The self-esteem scores decreased with the increase in the number of complications.
  
  
  CONCLUSIONS
  Our data suggest that despite frequent complications, bilateral lower limb lengthening increases patients' QOL. We believe lengthening is a reasonable option in selected patients.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Institute for Rare Diseases and Department of Orthopaedic Surgery, Korea University Medical Center, Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 152-703, South Korea.
authors.forename: Seung-Ju
authors.initials: SJ
authors.lastname: Kim
authors.forename: Gracia Cielo
authors.initials: GC
authors.lastname: Balce
authors.forename: Mandar Vikas
authors.initials: MV
authors.lastname: Agashe
authors.forename: Sang-Heon
authors.initials: SH
authors.lastname: Song
authors.forename: Hae-Ryong
authors.initials: HR
authors.lastname: Song
mesh_terms: D000130:Achondroplasia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D000293:Adolescent; D002648:Child; D005269:Femur / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique / Q000009:adverse effects*; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology* / Q000523:psychology; D011788:Quality of Life; D011859:Radiography; D020127:Recovery of Function; D056910:Republic of Korea; D012189:Retrospective Studies; D012649:Self Concept; D013977:Tibia / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome