Femur lengthening is a long and demanding journey that includes preparation, surgery and a gradual lengthening phase. Surgical technique is only one part of the equation. Preoperative physical conditioning, muscle flexibility, nutrition and lifestyle habits also play a major role in the final outcome.
This guide explains how to prepare your body for femur lengthening surgery, focusing on preoperative exercises, stretching routines, nutrition and weight management, and vitamin–mineral support.
During femur lengthening surgery, a complete osteotomy is performed on the femur. In other words, the bone is fully cut. Then, with the chosen system (for example LON, internal nails or other devices), the bone ends are gradually separated at a controlled rate and new bone is expected to form in between.
Throughout this process, the implants that are used for lengthening carry a significant portion of the body weight until the bone fully consolidates. The higher the body weight, the higher the mechanical load on the implants. At the same time, muscles, tendons and joints are under continuous tension. Entering surgery with stronger muscles, better flexibility and a healthier weight helps reduce mechanical risks and improves overall comfort during the lengthening period.
Preoperative exercise – often called “prehab” – aims to make the lengthening phase more tolerable and to support a smoother recovery. The main goals are to:
As a general rule, it is ideal to start a structured exercise program about 4–6 weeks before surgery. In patients with very weak muscles or marked stiffness, this period can be extended to 8–12 weeks. Exercising 4–5 days per week for about 30–45 minutes per session is usually sufficient, as long as it is tailored to the patient’s condition.
The following muscle groups are especially important:
Example strengthening exercises:
During the lengthening phase, muscles and tendons are constantly being stretched. Going into surgery with tight muscles makes this phase more painful and less comfortable. Regular stretching before surgery provides a significant advantage.
Ideally, stretching exercises should be performed every day, or at least 5 days per week.
Recommended basic stretches:
In femur lengthening surgery, the implants used for distraction and stabilization carry body weight until the bone fully consolidates. The higher the weight, the higher the mechanical load on the system. Excess weight can make walking training more difficult and may increase the risk of mechanical complications.
The main goal in the preoperative period is to achieve slow and controlled weight reduction without losing muscle mass, while ensuring adequate protein intake for bone and soft tissue healing.
Protein is essential for bone healing, maintaining muscle strength and supporting wound healing. Daily protein needs vary depending on body weight, age and medical conditions, but many adults require roughly 1.2–1.8 g of protein per kilogram of body weight. The exact target should be adjusted together with a physician or dietitian.
Good protein sources include: fish, chicken, turkey, lean red meat, eggs, yogurt, milk, cheese, kefir, lentils, chickpeas, beans and soy products.
A simple practical rule is to have a palm-sized portion of protein at each main meal.
Vitamins and minerals play a supportive role in bone and soft tissue healing. However, not every patient needs every supplement. The safest approach is to evaluate blood tests before surgery and to start targeted supplementation only where deficiencies are identified.
Vitamin D is important for bone metabolism and immune function. If a deficiency is present, appropriate vitamin D supplementation can be planned under medical supervision. Uncontrolled high-dose use should be avoided.
Whenever possible, calcium intake should first be optimized through diet. Dairy products, some green leafy vegetables and certain nuts are good calcium sources. In patients with osteoporosis or additional risk factors, extra calcium may be prescribed by the physician.
Anaemia can cause fatigue and slow down recovery after surgery. Checking haemoglobin, ferritin, vitamin B12 and folate levels before surgery is useful. If any deficiency is found, it should be corrected appropriately with medical treatment.
Smoking delays wound healing and increases the risk of infection and impaired bone healing. Ideally, it should be stopped at least 4–8 weeks before surgery and avoided completely afterwards.
Excessive alcohol intake weakens the immune system and may negatively affect recovery. Reducing or stopping alcohol consumption in the weeks leading up to surgery is strongly recommended.
Good-quality sleep supports pain control and tissue repair. Aim for 7–8 hours of sleep per night, limit late-night screen time and, if needed, seek professional help for stress management. Being mentally prepared for the lengthening process is just as important as physical preparation.
The timeline below provides a general framework for preoperative preparation. The exact plan should always be personalized:
Preoperative preparation is only one part of the process. To better understand what happens after surgery and how to protect your long-term results, you may also want to read the following articles:
Preoperative preparation for femur lengthening surgery directly affects technical success, comfort during the lengthening phase and the speed of recovery. A structured program that includes regular exercises and stretching, balanced nutrition and weight control, correction of vitamin–mineral deficiencies and healthy lifestyle habits helps make the entire process safer and more predictable.
Every patient is unique. The information in this guide provides a general framework, but your individual preparation plan should always be created together with your own medical team and, when needed, a physiotherapist and dietitian.
Sedat Duman, MD
With years of experience, Time To Be Taller serves its patients in its clinic located in Mall of Istanbul.
