Cost Comparison of Femoral Distraction Osteogenesis With External Lengthening Over a Nail Versus Internal Magnetic Lengthening Nail

J Am Acad Orthop Surg. 2019 May 1;27(9):e430-e436. doi: 10.5435/JAAOS-D-17-00741.


Introduction: Femoral lengthening is performed by distraction osteogenesis via lengthening over a nail (LON) or by using a magnetic lengthening nail (MLN). MLN avoids the complications of external fixation while providing accurate and easily controlled lengthening. However, the increased cost of implants has led many to question whether MLN is cost-effective compared with LON.

Methods: A retrospective review was performed comparing consecutive femoral lengthenings using either LON (n = 19) or MLN (n = 39). The number of surgical procedures, time to union, and amount of lengthening were compared. Cost analysis was performed using both hospital and surgeon payments. Costs were adjusted for inflation using the Consumer Price Index.

Results: No difference was observed in the length of femoral distraction. Patients treated with MLN underwent fewer surgeries (3.1 versus 2.1; P < 0.001) and had a shorter time to union (136.7 versus 100.2 days; P = 0.001). Total costs were similar ($50,255 versus $44,449; P = 0.482), although surgeon fees were lower for MLN ($4,324 versus $2,769; P < 0.001).

Discussion: Although implants are more expensive for MLN than LON, this appears to be offset by fewer procedures. Overall, the two procedures had similar total costs, but MLN was associated with a decreased number of procedures and shorter time to union.

Level of evidence: III.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Bone Lengthening / economics*
  • Bone Lengthening / methods*
  • Bone Nails / economics*
  • Cost-Benefit Analysis*
  • Costs and Cost Analysis*
  • Female
  • Femur / surgery*
  • Humans
  • Magnetics / economics*
  • Male
  • Middle Aged
  • Osteogenesis, Distraction / economics*
  • Osteogenesis, Distraction / methods*