That's an interesting post. It would be great to hear from people who had internal femurs done and if they have any complications say from two years onwards. The operation is costly both financially and in time. Considering the "cheapest" for internals in Europe is 48,000 euros not including accommodation/physio/food which is possibly another 8000 euros if one decides to stay for the entire lengthening period. ( say three months for 7.5cm) As well the person is out of work which I'm guessing for five months before walking "normally", that is nearly three months for lengthening and two months for consolidation (on crutches). That's five months out of your life and work ( if your job entails walking a lot or doing community work). It's a big sacrifice.
http://www.childrenshospital.org/centers-and-services/anterior-cruciate-ligament-program/bridge-enhanced-acl-repair-trial
What do you guys think about this?! if the problem with this operation will be the knee? is it possible to recover 100% from this operation?
http://www.childrenshospital.org/centers-and-services/anterior-cruciate-ligament-program/bridge-enhanced-acl-repair-trial
What do you guys think about this?! if the problem with this operation will be the knee? is it possible to recover 100% from this operation?
New study shows that increasing Tibia/Femur ratio beyond 0.8 is correlated with long-term arthritis.
Copy paste from link https://www.ncbi.nlm.nih.gov/pubmed/26398436:
The Association of Tibia Femur Ratio and Degenerative Disease of the Spine, Hips, and Knees.
Weinberg DS1, Liu RW.
Author information
Abstract
BACKGROUND:
When individuals with asymmetric lower extremities present for evaluation of limb-length inequality, correction can occur at the tibia, femur, or in both bones; however, there are limited data available to justify either technique. The aim of this study is to examine the normal ratio of tibia length/femur length (T/F), and to explore the relationship between T/F ratio and osteoarthritis of the spine, hips, and knees.
METHODS:
Bone lengths of 1152 cadaveric femora and tibiae from the Hamann-Todd osteological collection were measured. Degenerative joint disease was graded in the hip, knee, and spine. Correlations between the ratio of T/F and osteoarthritis were evaluated with multiple regression analysis.
RESULTS:
The average ratio of T/F was 0.80±0.03. There was a strong correlation between age and arthritis at all sites, with standardized β ranging from 0.44 to 0.57 (P<0.0005 for all). There was a significant correlation between increasing T/F and hip arthritis (standardized β=0.08, P=0.006), and knee arthritis (standardized β=0.08, P=0.008).
DISCUSSION:
Increasing tibia length relative to femur length was found to be a significant predictor of ipsilateral hip and knee arthritis. Therefore, we recommend that when performing limb lengthening, surgical planning should lean toward recreating the normal ratio of 0.80. In circumstances where one bone is to be overlengthened relative to the other, bias should be toward overlengthening the femur. This same principle can be applied to limb-reduction surgery, where in certain circumstances, one may choose to preferentially shorten the tibia.
CLINICAL RELEVANCE:
This is the first study to report long-term consequences of lower extremity segment disproportion.
New study shows that increasing Tibia/Femur ratio beyond 0.8 is correlated with long-term arthritis.
Copy paste from link https://www.ncbi.nlm.nih.gov/pubmed/26398436:
The Association of Tibia Femur Ratio and Degenerative Disease of the Spine, Hips, and Knees.
Weinberg DS1, Liu RW.
Author information
Abstract
BACKGROUND:
When individuals with asymmetric lower extremities present for evaluation of limb-length inequality, correction can occur at the tibia, femur, or in both bones; however, there are limited data available to justify either technique. The aim of this study is to examine the normal ratio of tibia length/femur length (T/F), and to explore the relationship between T/F ratio and osteoarthritis of the spine, hips, and knees.
METHODS:
Bone lengths of 1152 cadaveric femora and tibiae from the Hamann-Todd osteological collection were measured. Degenerative joint disease was graded in the hip, knee, and spine. Correlations between the ratio of T/F and osteoarthritis were evaluated with multiple regression analysis.
RESULTS:
The average ratio of T/F was 0.80±0.03. There was a strong correlation between age and arthritis at all sites, with standardized β ranging from 0.44 to 0.57 (P<0.0005 for all). There was a significant correlation between increasing T/F and hip arthritis (standardized β=0.08, P=0.006), and knee arthritis (standardized β=0.08, P=0.008).
DISCUSSION:
Increasing tibia length relative to femur length was found to be a significant predictor of ipsilateral hip and knee arthritis. Therefore, we recommend that when performing limb lengthening, surgical planning should lean toward recreating the normal ratio of 0.80. In circumstances where one bone is to be overlengthened relative to the other, bias should be toward overlengthening the femur. This same principle can be applied to limb-reduction surgery, where in certain circumstances, one may choose to preferentially shorten the tibia.
CLINICAL RELEVANCE:
This is the first study to report long-term consequences of lower extremity segment disproportion.
Quote from: Medium Drink Of Water on May 20, 2014, 08:39:50 PMI have:
-Altered sensation in my knees when kneeling or touching them, around the IM nail insertion sites and around the osteotomy sites
-Stiffness in my knees unless I exercise regularly
-Hypersensitivity in my knees when kneeling on a hard surface
-Worse balance than before
-A left ostoetomy scar that's thin and weak, that I have to protect from getting bumped or it'll break and bleed
-Altered mechanics in my legs which led to exertional compartment syndrome when walking, requiring fasciotomy
I hope my posts and diary here don't whitewash the issues I've dealt with and continue to deal with as an LLer. I did it and got my 3 inches without getting crippled. Those 3 inches changed my life, but sacrifices were made. LL is a tradeoff and there are consequences I'll have to live with from now on.
3 inches in the tibias is a lot, and more than what most doctors would recommend. I know LL is costly, but if you're concerned about complications, split the increase in height across the tibias and femurs. That way you can get 2 + 2 inches with far less risk.
Quote from: alps on December 07, 2014, 01:11:04 PMhow do you suggest we end our own lives?
You can go all high-tech about it 
No, seriously, get the money for a top doctor and you'll be fine.
Quote from: musicmaker on February 10, 2015, 05:43:27 PMFat embolism, for example, isn’t a theoretical complication, but a very real risk which is usually silenced in the forum and however happens. And there are patients from the best surgeons in the world who die from it. I’ve been told this by a very reliable source from a medical point of view.
Where did that happen and why wasn't the surgeon sued for malpractice?
Quote from: musicmaker on February 10, 2015, 05:43:27 PMCan we do anything to avoid these risks? [...] It’s better not doing more than one segment at once and even avoiding CLL if possible.
Exactly. Paley advises against doing both segments at once. I'll be doing them three weeks apart.
Quote from: Madmax_01 on December 18, 2015, 01:19:26 AMtibia lenghtening seems to have a lot of correlation when it comes to knee problems. I was wondering if the same applies to femur lenghtening.
I've asked Dr. Paley about knee pain following insertion of nail in the tibias. His reply:
QuoteVery little if any knee pin in our patients with CLL after tibial lengthening. I think it has to do with the minimally invasive we we insert the rod and avoid damage or irritation to the patellar tendon.
Quote from: Alu on December 18, 2015, 02:33:53 AMSo honestly If you want max gain of 8-10 and keep good recovery (we have no idea if we can get back to 100%; 90% seems close so far but who knows) then splitting the surgeries would be the most advantageous.
Exactly. That's my research too so far after spending weeks reading a ton of patient diaries. Keep your lengthening to 5-6 cm in the femur and 5 in the tibias, and pay attention to when physical therapy during the lengthening phase become suddenly more difficult - and stop there. The extra 1 or 2cm is NOT worth the pain and complications. Think 2 years to return to normal function instead of 6 months. Do you want that? In that year and a half you might as well earn the money to pay the difference between just femurs and femurs+tibias. This is the route I'm taking.
Quote from: Medium Drink Of Water on May 20, 2014, 08:39:50 PMI have:
-Altered sensation in my knees when kneeling or touching them, around the IM nail insertion sites and around the osteotomy sites
-Stiffness in my knees unless I exercise regularly
-Hypersensitivity in my knees when kneeling on a hard surface
-Worse balance than before
-A left ostoetomy scar that's thin and weak, that I have to protect from getting bumped or it'll break and bleed
-Altered mechanics in my legs which led to exertional compartment syndrome when walking, requiring fasciotomy
I hope my posts and diary here don't whitewash the issues I've dealt with and continue to deal with as an LLer. I did it and got my 3 inches without getting crippled. Those 3 inches changed my life, but sacrifices were made. LL is a tradeoff and there are consequences I'll have to live with from now on.
3 inches in the tibias is a lot, and more than what most doctors would recommend. I know LL is costly, but if you're concerned about complications, split the increase in height across the tibias and femurs. That way you can get 2 + 2 inches with far less risk.
Quote from: alps on December 07, 2014, 01:11:04 PMhow do you suggest we end our own lives?
You can go all high-tech about it
No, seriously, get the money for a top doctor and you'll be fine.
Quote from: musicmaker on February 10, 2015, 05:43:27 PMFat embolism, for example, isn’t a theoretical complication, but a very real risk which is usually silenced in the forum and however happens. And there are patients from the best surgeons in the world who die from it. I’ve been told this by a very reliable source from a medical point of view.
Where did that happen and why wasn't the surgeon sued for malpractice?
Quote from: musicmaker on February 10, 2015, 05:43:27 PMCan we do anything to avoid these risks? [...] It’s better not doing more than one segment at once and even avoiding CLL if possible.
Exactly. Paley advises against doing both segments at once. I'll be doing them three weeks apart.
Quote from: Madmax_01 on December 18, 2015, 01:19:26 AMtibia lenghtening seems to have a lot of correlation when it comes to knee problems. I was wondering if the same applies to femur lenghtening.
I've asked Dr. Paley about knee pain following insertion of nail in the tibias. His reply:
QuoteVery little if any knee pin in our patients with CLL after tibial lengthening. I think it has to do with the minimally invasive we we insert the rod and avoid damage or irritation to the patellar tendon.
Quote from: Alu on December 18, 2015, 02:33:53 AMSo honestly If you want max gain of 8-10 and keep good recovery (we have no idea if we can get back to 100%; 90% seems close so far but who knows) then splitting the surgeries would be the most advantageous.
Exactly. That's my research too so far after spending weeks reading a ton of patient diaries. Keep your lengthening to 5-6 cm in the femur and 5 in the tibias, and pay attention to when physical therapy during the lengthening phase become suddenly more difficult - and stop there. The extra 1 or 2cm is NOT worth the pain and complications. Think 2 years to return to normal function instead of 6 months. Do you want that? In that year and a half you might as well earn the money to pay the difference between just femurs and femurs+tibias. This is the route I'm taking.
Quote from: fivefive on February 10, 2018, 12:25:44 AM
Where did that happen and why wasn't the surgeon sued for malpractice?
I don't know what doctor MM talks about. All I can say is patients sign a medical consent form where it says that fat embolism is a possible side effect of this surgery. When you get this surgery you must assume that death is a possible, if highly unlikely, risk. Doctors can't be sued if you die from fat embolism since it's a well known, though highly unlikely, side effect of this surgery.
Quote from: fivefive on February 10, 2018, 12:25:44 AM
Where did that happen and why wasn't the surgeon sued for malpractice?
I don't know what doctor MM talks about. All I can say is patients sign a medical consent form where it says that fat embolism is a possible side effect of this surgery. When you get this surgery you must assume that death is a possible, if highly unlikely, risk. Doctors can't be sued if you die from fat embolism since it's a well known, though highly unlikely, side effect of this surgery.
reviving the thread since I also want onions on pitfalls on lon/latn vs complete external. In pm many people advised me against latn/lon, but going full external woyld mean 9 months out of job.
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