Dr Franz Birkholtz - CLL in Stellenbosch, South Africa

Edit Post

Dr. Birkholtz, two questions:

1. During a live episode with Victor, you said 9-12 months post-surgery was a reasonable amount of time to return to office work.

I was surprised, as patient diaries here describe being able to walk anywhere you need, albeit with a limp and a cane, soon after distraction. Could you elaborate on this?

2. How do you advise patients obtain X-rays for their initial remote consultation with you, and what kind of X-rays should they request?

Edit Post

Hi

1) Return to walking and office based work depends on a number of factors eg age, quality of bone, amount lengthened, nails used, complications etc. Also, office based work may include long commutes to get there, climbing stairs etc. Taking all this in consideration, 9 months is a conservative estimate, but realistically, most patients would come off crutches between 6 and 9 months.

2) The standard xray is a longleg standing alignment xray with the patellae facing forward and visible size marker - Ap and Lat views.
This can be done by any good radiology department, but depending on where you are, you may need a local doctor to prescribe the xray.

Edit Post

He'll Doctor,

Is there a way to avoid permanent or longterm knee pain when using an internal nail for tibia lengthening? I've heard that many tibia CLL patients have developed longterm knee pain after consolidation when they've used internal nails such as Precise and LON

Edit Post

Good question Wes.

The research indicates risk of permanent knee pain can be minimized by keeping the nail tip out of the proximal third and the prominence less than 5 mm, so a better question might be whether those things can be avoided.

Thank you Dr. Birkholtz!

Edit Post

Quote from: BeginAgain on July 17, 2024, 08:44:47 PMGood question Wes.

The research indicates risk of permanent knee pain can be minimized by keeping the nail tip out of the proximal third and the prominence less than 5 mm, so a better question might be whether those things can be avoided.

Thank you Dr. Birkholtz!

Can those be avoided?

Edit Post

Are you offering Precise Max?

Edit Post

Quote from: wes07 on July 17, 2024, 09:48:26 PMCan those be avoided?

Good questions.
In principle, a nail can be inserted and seated properly.
Still, knee pain may still be present. There is a portion of patients who get tibial nails who still have knee pain afterwards. A suprapatellar nail entry may help in limiting the risk.

Edit Post

Quote from: Franz on July 22, 2024, 07:42:14 PMGood questions.
In principle, a nail can be inserted and seated properly.
Still, knee pain may still be present. There is a portion of patients who get tibial nails who still have knee pain afterwards. A suprapatellar nail entry may help in limiting the risk.

Nobody offers Precice Max at the moment, as the nail has been withdrawn ‘temporarily’.

At least, this is my understanding.

Edit Post

Quote from: Franz on July 22, 2024, 07:43:39 PMNobody offers Precice Max at the moment, as the nail has been withdrawn ‘temporarily’.

At least, this is my understanding.

Hello Dr Franz
What about the Orthofix weight bearing nail you talked about with Cyborg4life about a year ago? Can you use that one?

Edit Post

Yes, that was the Fitbone Troch entry nail.
It is made from steel rather than titanium, so more resistance to bending.
Likely stronger. But like the PMax, it will not be called weight bearing by the FDA or the company.
I do believe it will allow us a more aggressive rehab protocol.
We should have it available soon.