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    Intramedullary distraction for lower limb lengthening

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    4 Committee considerations

    The evidence

    4.1 NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 7 sources, which was discussed by the committee. The evidence included 5 systematic reviews, 1 retrospective cohort study and 1 retrospective matched case series. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.

    4.2 The professional experts and the committee considered the key efficacy outcomes to be: achievement of target limb length, improved function and improved quality of life.

    4.3 The professional experts and the committee considered the key safety outcomes to be: pain, infection, device related complications, and delayed or non-union.

    Committee comments

    4.4 The committee noted that:

    • the technology used for limb lengthening is evolving and external fixator use has become less common

    • there are several devices available for use in this procedure, and they may have different efficacy and safety profiles

    • this procedure is only for use in people who have limb length discrepancy and not for overall height gain

    • assessing and managing the soft tissues is key to successful outcomes.

    Tom Clutton-Brock
    Chair, interventional procedures advisory committee
    October 2021

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