A boy in Dubai with a rare bone condition has had successful leg-lengthening surgery to treat it.
Eyad Emadeldin Mousa Ali, 12, was born with tibial hemimelia, in which all or part of the tibia, the shinbone, is missing.
If bone is missing in one leg, the condition creates what doctors call a leg length discrepancy.
Eyad's healthy leg grew, but the other was 11 centimetres shorter and he was unable to walk freely.
The first few months it was very difficult. He cried so much from the pain, my heart also cried with him.
Doctors decided he needed surgery to lengthen his leg. Without it, Eyad would have faced problems with his spine and pelvis, they said.
In this procedure, a metal rod was inserted into the bone and a device that slowly moves the two ends of the bone apart was attached. As space between the two ends widens, bone grows in.
After three years of operations and follow-up care by Dr Anand Gorva, a paediatric orthopaedic surgeon and limb reconstruction specialist at Medcare Orthopaedic Hospital in Dubai, Eyad is walking and swimming with his friends, much to the relief of his mother, Marwa Adel.
Long road to recovery
His first operation was in October 2019 at Medcare Orthopaedic Hospital.
“The first nine-hour surgery was very difficult, it was a long day for everyone,” Ms Adel said.
“It was very hard for Eyad as he felt so much pain. So many people came to see him and he became a famous boy in the hospital.
“After two days, he started to walk with help from the physiotherapist on the doctor’s instructions but it was difficult for him in the beginning.”
Those small steps were the first on a long road to recovery for Eyad, who would spend weeks in a wheelchair.
A second operation at Medcare Orthopaedic took place in July 2020, and the cast was removed three months later to allow a brace to be fitted.
Despite the daily challenges of the frame around his leg, Eyad excelled in his homeschooling, scoring 95 per cent in the year.
He was treated to a visit to a Ferrari showroom in Dubai, and a trip around the city in his favourite sports car.
“For the first few months it was very difficult,” said Ms Adel, an Egyptian who now lives with her son in Saudi Arabia.
“Eyad was in so much pain and, as we were at home, he had no access to drugs, only ibuprofen or panadol, which was not enough.
“Every day I was doing the lengthening on the device by hand. He cried so much from the pain, my heart also cried.
“He asked so many questions. Why him, and why he was not normal like his sisters and friends?
“I tried my best to be strong for him, and day by day he got familiar with the device and started to walk by himself. Really, he is the strongest boy I have ever seen.”
The family searched for two years for a hospital to complete the surgery within the budget of their health insurance plan, then Dr Gorva stepped in to take on the complicated procedure.
He said magnetic rods are now the most commonly used method of limb lengthening.
These are placed inside the patient's shorter bone through a small incision, with gradual lengthening performed by an external electromagnet.
“I have just taken on two new patients who will use either titanium or stainless steel rods,” said Dr Gorva, who has performed about 100 similar operations in the UK.
“But they (rods) can only expand to a certain length, and cannot be walked on during the lengthening process as they could jam.
“Once we lengthen the limbs and the patient recovers, we take the rods out. It usually lengthens a millimetre a day, so five centimetres would take at least 50 days of lengthening time.
“The bone takes around three times the lengthening time to heal, so that can be 150 days in this case.”
Eyad faces two more operations as he grows.
Growing demand for cosmetic leg-lengthening
Limb lengthening procedures are usually associated with correcting deformities, gunshot wounds or bone loss.
But there is a growing demand in the Middle East for cosmetic procedures for those wanting to increase their height.
There are two ways of lengthening the bone, using an external fixator where a rod is fixed in place outside of the skin, called pin fixation.
Otherwise, a magnetic rod is inserted inside the bone, and gradually lengthens itself by an external device given to the patient to operate.
After 10 days, patients will have added around a centimetre in height.
For 3cm to 5cm, the maximum recommended, it would usually take a minimum of 60 days.
“We do many deformity corrections and limb lengthening for congenital deformities,” said Dr Mahantesh Magadum, an orthopaedic surgeon at Burjeel Hospitals.
“As for cosmetics, there are fewer but there is a lot more interest now than there has been in the past.
“Some people have low self-esteem because they are short. We are getting more enquires, but it is a complex, and expensive procedure.”
The high costs
The price depends on the materials used, but one rod can cost Dh120,000.
For cosmetic procedures two rods are required, with additional hospital fees bills can exceed Dh500,000.
“We do very few cosmetic procedures, maybe around two or three a month,” Dr Magadum said.
“The surgery takes an hour per bone, and the post-op protocol is needed with good follow-up care, patient commitment and follow-up care.
“Soon we will have lower-cost nails, and that will bring the price down so it may become even more popular in the near future.”