September 16, 2025

Tibia or Femur in Limb Lengthening? Planning Two Segments and Timing in the Same Patient

Tibia or Femur in Limb Lengthening? Two-Segment Planning • Timing

When planning limb lengthening, the pivotal question is: tibia or femur? Some patients may benefit from both segments. This guide compares tibia vs femur, outlines two-segment strategies, and explains how to time them safely.

Updated: 09 September 2025 • Surgeon’s protocol is decisive

Introduction

There are multiple routes to reach a height goal. Each segment differs in bone biology, soft-tissue tolerance and aesthetic impact. The right choice aligns expectations, proportionality and risk management.

Tibia Lengthening

Pros: Robust cortical bone and vascularity → consolidation often predictable.
Aesthetic effect: Lower-leg lengthening can noticeably refine gait appearance.
Limits: Beyond ~5–6 cm the risks of Achilles tightness, equinus and stiffness rise.

Femur Lengthening

Pros: Wide canal and stable implants; up to ~7–8 cm generally considered safe.
Comfort: Sitting tolerance and knee loading are often manageable.
Challenges: Quad/hamstring tightness may increase pain and reduce ROM.

Which Segment When?

Long torso / short legs: Prioritise tibia to restore balance.
Higher cm goal with good flexibility: Femur can be the first choice.
Long thighs / short lower legs look: Tibia helps harmonise silhouette.
Short thigh / balanced tibia: Femur is more suitable.

Two Segments in the Same Patient

Simultaneous (Femur + Tibia in the Same Period)

Pros: Shorter overall timeline; greater total cm.
Cons: Tougher pain control and physiotherapy; higher complication risk.

Staged (One First, the Other Later)

Pros: Load and risk spread more controllably.
Cons: Longer total treatment (often 1.5–2 years).

Timing Strategies

Many centres start with the femur (higher gain, stable fixation).
Tibia can be scheduled as the second stage.
Allow at least 12–18 months between stages—wait for full bone strength before the second segment.
Simultaneous two-segment plans should be reserved for experienced centres and carefully selected patients.

Conclusion

There is no single answer to “tibia or femur?”. Consider proportions, target centimetres, flexibility and psychological resilience to build a patient-specific plan that balances ambition and safety.