Aim and objective: Tibial lengthening can be performed by distraction osteogenesis via lengthening and then nailing (LATN) or by using a magnetic lengthening nail (MLN). MLN avoids the complications of external fixation while providing accurate and easily controlled lengthening. Concerns exist still regarding the high upfront cost of the magnetic nail, which serves to limit its use in resource-poor areas and decrease adoption among cost-conscious surgeons. The purpose of this study was to compare the hospital, surgeon, and total cost between LATN and MLN when used for tibial lengthening.
Materials and methods: A retrospective review was performed comparing consecutive tibial lengthening using either LATN (n = 17) or MLN (n = 15). The number of surgical procedures and time to union were compared. Surgeon and hospital payments were used to perform cost analysis after adjusting for inflation using the consumer price index (CPI).
Results: Patients treated with MLN underwent fewer surgeries (3.6 vs 2.8; p < 0.001) but had a longer time to union as compared with patients treated with LATN (19.79 vs 27.84 weeks; p = 0.006). Total costs were similar ($50,345 vs $46,162; p = 0.249) although surgeon fees were lower for MLN as compared with LATN ($6,426 vs $4,428; p < 0.001).
Conclusion: LATN and MLN had similar overall costs in patients undergoing tibial lengthening. MLN was associated with fewer procedures but a longer time to union as compared with LATN.
Clinical significance: Despite an increased upfront cost in MLN, there was no difference in total cost between LATN and MLN when used for tibial lengthening. Thus, in cases where either method is feasible, cost may not be a deciding factor when selecting the appropriate treatment.
Kim HJ, Fragomen AT, Reinhardt K, et al. Lengthening of the femur over an existing intramedullary nail. J Orthop Trauma 2011;25(11):681–684. DOI: 10.1097/BOT.0b013e3181f92d6e.
Sangkaew C. Distraction osteogenesis of the femur using conventional monolateral external fixator. Arch Orthop Trauma Surg 2008;128(9):889–899. DOI: 10.1007/s00402-007-0437-1.
Wan J, Ling L, Zhang XS, et al. Femoral bone transport by a monolateral external fixator with or without the use of intramedullary nail: a single-department retrospective study. Eur J Orthop Surg Traumatol 2013;23(4):457–464.DOI: 10.1007/s00590-012-1008-x.
Gordon JE, Manske MC, Lewis TR, et al. Femoral lengthening over a pediatric femoral nail: results and complications. J Pediatr Orthop 2013;33(7):730–736. DOI: 10.1097/BPO.0b013e3182a122a1.
Paley D, Herzenberg JE, Paremain G, et al. Femoral lengthening over an intramedullary nail. A matched-case comparison with ilizarov femoral lenghtening. J Bone Joint Surg Am 1997;79(10):1464–1480. DOI: 10.2106/00004623-199710000-00003.
Song HR, Oh CW, Mattoo R, et al. Femoral lengthening over an intramedullary nail using the external fixator: risk of infection and knee problems in 22 patients with a follow-up of 2 years or more. Acta Orthop 2005;76(2):245–252. DOI: 10.1080/00016470510030652.
Watanabe K, Tsuchiya H, Sakurakichi K, et al. Tibial lengthening over an intramedullary nail. J Orthop Sci 2005;10(5):480–485. DOI: 10.1007/s00776-005-0939-z.
Xu W. Comparison of intramedullary nail versus conventional Ilizarov method for lower limb lengthening: a systematic review and meta-analysis. Orthop Surg 2017;9(2):159–166. DOI: 10.1111/os.12330.
Laubscher M, Mitchell C, Timms A, et al. Outcomes following femoral lengthening: an initial comparison of the precice intramedullary lengthening nail and the lrs external fixator monorail system. Bone Joint J 2016;98-B(10):1382–1388. DOI: 10.1302/0301-620X.98B10.36643.
Mahboubian S, Seah M, Fragomen AT, et al. Femoral lengthening with lengthening over a nail has fewer complications than intramedullary skeletal kinetic distraction. Clin Orthop Relat Res 2012;470(4):1221–1231. DOI: 10.1007/s11999-011-2204-4.
Lee DH, Ryu KJ, Song HR, et al. Complications of the Intramedullary Skeletal Kinetic Dissiteor (ISKD) in distraction osteogenesis. Clin Orthop Relat Res 2014;472(12):3852–3859. DOI: 10.1007/s11999-014-3547-4.
Rozbruch SR, Birch JG, Dahl MT, et al. Motorized intramedullary nail for management of limb-length discrepancy and deformity. J Am Acad Orthop Surg 2014;22(7):403–409. DOI: 10.5435/JAAOS-22-07-403.
Paley D. PRECICE intramedullary limb lengthening system. Expert Rev Med Devices 2015;12(3):231–249. DOI: 10.1586/17434440.2015.1005604.
Kirane YM, Fragomen AT, Rozbruch SR. Precision of the PRECICE® internal bone lengthening nail. Clin Orthop Relat Res 2014;472(12):3869–3878. DOI: 10.1007/s11999-014-3575-0.
Bernstein M, Fragomen AT, Sabharwal S, et al. Does integrated fixation provide benefit in the reconstruction of posttraumatic tibial bone defects? Clin Orthop Relat Res 2015;473(10):3143–3153. DOI: 10.1007/s11999-015-4326-6.
Rozbruch SR, Fragomen AT. Lengthening of the femur with a remote-controlled magnetic intramedullary nail: antegrade technique. JBJS Essent Surg Tech 2016;6(1):e2. DOI: 10.2106/JBJS.ST.O.00063.
Fragomen AT, Rozbruch SR. Lengthening and deformity correction about the knee using a magnetic internal lengthening nail. SICOT J 2017;3:25. DOI: 10.1051/sicotj/2017014.
Rozbruch SR. Adult posttraumatic reconstruction using a magnetic internal lengthening nail. J Orthop Trauma 2017;31(6 Suppl):S14–S19. DOI: 10.1097/BOT.0000000000000843.
Fragomen AT, Rozbruch SR. Lengthening of the femur with a remote-controlled magnetic intramedullary nail: retrograde technique. JBJS Essent Surg Tech 2016;6(2):e20. DOI: 10.2106/JBJS.ST.15.00069.
Horn J, Grimsrud Ø, Dagsgard AH, et al. Femoral lengthening with a motorized intramedullary nail. A matched-pair comparison with external ring fixator lengthening in 30 cases. Acta Orthop 2015;86(2):248–256. DOI: 10.3109/17453674.2014.960647.
Wiebking U, Liodakis E, Kenawey M, et al. Limb Lengthening using the PRECICETM nail system: complications and results. Arch Trauma Res 2016;5(4):e36273. DOI: 10.5812/ATR.36273.
Rozbruch SR, Kleinman D, Fragomen AT, et al. Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison. Clin Orthop Relat Res 2008;466(12):2923–2932. DOI: 10.1007/s11999-008-0509-8.
Liu H, Cella D, Gershon R, et al. Representativeness of the patient-reported outcomes measurement information system internet panel. J Clin Epidemiol 2010;63(11):1169–1178. DOI: 10.1016/j.jclinepi.2009.11.021.
Fragomen AT, Kurtz AM, Barclay JR, et al. A comparison of femoral lengthening methods favors the magnetic internal lengthening nail when compared with lengthening over a nail. HSS J 2018;14(2):166–176. DOI: 10.1007/s11420-017-9596-y.
Richardson SS, Schairer WW, Fragomen AT, et al. Cost comparison of femoral distraction osteogenesis with external lengthening over a nail versus internal magnetic lengthening nail. J Am Acad Orthop Surg 2019;27(9):e430–e436. DOI: 10.5435/JAAOS-D-17-00741.
Ryu KJ, Kim BH, Hwang JH, et al. Reamed intramedullary nailing has an adverse effect on bone regeneration during the distraction phase in tibial lengthening. Clin Orthop Relat Res 2016;474(3):816–824. DOI: 10.1007/s11999-015-4613-2.