Mended But Not Healed - Somatic and Mental Health 10 Years after Leg Lengthening with Ilizarov

Abstract

Objective: To study the somatic and mental health in patients who had leg lengthening (LL) in a 10-year follow-up and to compare it with the 1 year-follow-up. Earlier studies have demonstrated severe maladaptive reactions in children and adolescents on a short term basis but also that they tolerate it without sustained psychological impact. Cohort sequential longitudinal studies, in which individuals from different age groups are followed over time, are needed to tease apart aging and cohort effects. Methods: This was a prospective study with 28 patients, mean age of 20, who had undergone leg lengthening (LL) between 1997-2005 at the Department of Pediatric Orthopedics, Uppsala University Hospital. The somatic health was studied by a structured medical assessment of the reconstructed leg and an interview focused on the patient’s experiences of surgery, outcome and function. The mental health was studied by Beck depression- and the State-Trait Anxiety Inventories and a specially designed questionnaire for patient with LLI. Results: When the patients rated their mental health, 20 were within a normal level and 7 had symptoms of depression. Patients’ self-esteem was on a median level. Those who had scored highly on the depression inventory also had high levels on both State- and Trait anxiety scale. Conclusion: One fourth of the patients reported themselves to be depressed at the 10-year follow-up, while 7% of the patients were depressed one year after LL. Self-esteem results for the cohort were on a median level, both one and ten years after LL. Interview data demonstrated that the majority of patients were preoccupied with their LLI and more psychological support during the lengthening period would have been desirable. From available data we cannot conclude that the leg lengthening per se caused the depressive symptoms in the patients.